When top-ranked health systems share their brands with smaller, unranked hospitals through affiliations, the standards of quality and safety don't always translate, according to a recent study.
A cohort study, published in the journal JAMA Network, found a nearly 1.7-fold difference in probability of 90-day mortality risk after complex cancer treatment at affiliate hospitals compared to the top-ranked health system they partnered with. Long-term survival was also inferior.
The researchers, led by Daniel Boffa in the Department of Surgery at the Yale School of Medicine, looked at data from the National Cancer Database of nearly 120,000 patients who underwent surgery for esophageal, gastric, lung, pancreatic, colorectal, and bladder cancers between 2012 and 2016.
This is significant, because brand-sharing has the potential to influence patients’ hospital preferences, the authors wrote in the study. They pointed to a nationally representative survey that showed half of respondents believed safety, quality and cure rates would be the same between top-ranked hospitals and their affiliates.
"Furthermore, respondents indicated that affiliation with a top-ranked cancer hospital would increase their preference for a local hospital," they wrote.
Among the differences, the researchers observed top-ranked hospitals performed more than twice the annual volume of affiliate hospitals. That could be significant, because higher surgical volumes have been associated with higher quality and safety measures.
The study also found:
- Patients at top-ranked cancer hospitals were more likely (20.8%) to receive preoperative chemotherapy compared to those at affiliate hospitals (7.8%).
- A staging or diagnostic procedure was performed in 60.9% of patients at top-ranked hospitals and 61.5% of patients at affiliates.
- A greater proportion of top-ranked hospitals were academic hospitals (97.3%) compared to affiliates (20%).
Adjusted long-term survival following cancer treatment at affiliate hospitals was only 77% that of top-ranked hospitals. The survival advantage was not fully explained by differences in annual surgical volume, with both long- and short-term survival remaining superior at top-ranked hospitals even after models were adjusted for volume, the authors wrote.
"These findings suggest that quality improvement efforts are needed to address important differences in survival between top-ranked cancer hospitals and brand-sharing affiliate hospitals," the authors wrote in the study.
This is not the first study to question how well the quality of smaller affiliates of top cancer center brands stack up.
Another study, published last year, came to a similar conclusion about lower mortality rates among Medicare beneficiaries. Researchers found about 50% of those patients had complex cancer surgery at a top-ranked hospital, and about 41% had surgery at an affiliate hospital. Overall, they found surgery performed at one of the affiliated hospitals was associated with a higher 90-day mortality rate.