Institutional Factors Associated with Adherence to Quality Measures for Stage I/II Non-Small Cell Lung Cancer

Structured Abstract Objective While previous studies have identified variation in quality lung cancer care, existing quality metrics may not fully capture the complexity of cancer care. The Thoracic Surgery Outcomes Research Network recently developed quality measures to address this. We evaluate baseline adherence to these measures, and identify factors associated with adherence. Methods Patients with pathologic stage I/II non-small cell lung cancer from 2010-2015 were identified in the National Cancer Database. Patient-level and hospital-level adherence to seven quality measures was calculated. Goal hospital adherence threshold was 85%. Factors influencing adherence were identified using multi-level logistic regression. Results We identified 253,182 patients from 1,324 hospitals. Lymph node sampling was performed in 91% of patients nationally, but only 76% of hospitals met the 85% adherence mark. Similarly, 89% of T1b (7th edition staging) tumors had anatomic resection, with 69% hospital-level adherence. Sixty-nine percent of pathologic stage II patients were recommended chemotherapy, with only 23% hospitals adherent. Eighty-three percent of patients had biopsy prior to primary radiation, with 64% hospitals adherent. Higher volume and academic institutions were associated with non-adherence to adjuvant chemotherapy and radiation therapy measures. Conversely, lower volume and non-academic institutions were associated with inadequate nodal sampling and non-anatomic resection. Conclusions Significant gaps continue to exist in the delivery of quality care to patients with early-stage lung cancer. Interestingly, high-volume academic hospitals had higher adherence for surgical care measures, but lower rates for coordination of care measures. This requires further investigation, but suggests targets for quality improvement may vary by institution type.