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Hospital Efficiency Impact on Quality of Prostate Cancer Care

February 25, 2021


Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, discusses a study which examined the association between hospital efficiency and quality of care in African American, Hispanic, and white Medicare beneficiaries with prostate cancer.

This study was presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.


Ravi Jayadevappa, Associate Professor at the Department of Medicine, here at Perelman School of Medicine, University of Pennsylvania.

I am going to today talk briefly about the hospital efficiency and quality of prostate cancer care and this study has been funded from the AHRQ R01 grant.

Briefly about the burden of prostate cancers, we all know that it is again number 1 cancer around men. In 2020 alone, there were about 191,000 newly diagnosed prostate cancer patients with a mean‑age at diagnosis of 69 years.

Overall, the expenses of prostate cancer, annual expenditure is around $50 billion. Having said that, hospitals play a critical role in providing care for prostate cancer patients, whether it is surgery, radiation, or other treatments, chemotherapy, and androgen deprivation therapy as well. In 2019, there are about 5,534 hospitals.

What led to our objective of the study, is how the hospital efficiency play an important role in providing quality of prostate cancer care across racial, ethnic group, as well as comorbidity. I'm not going to discuss too much into some of the sub‑analysis work we did. We are overall going to give you overview of how the hospital efficiency is correlated to, in terms of quality-of-care outcomes.

Having said that, hospital systems almost account for 5.6% of GDP. Measuring and monitoring hospital efficiency, it's an important way to help us to improve the quality of care as well as cut down the cost of care. Our study is the conceptual model of quality of care, it includes structure, process, and outcomes.

We are looking at the structure, especially the technical efficiency of the hospital, how would that impact mortality, readmission, complications, health resource utilization, and cost. To do that, what we are doing is we are using the SEER-Medicare linked data. This Medicare claims data and linked to the SEER registry.

We have linked the SEER-Medicare data with the hospital AHA data, that is American Hospital Association data. This is a retrospective cohort design, including inclusions of all African American, Hispanic, Asian, Caucasian men diagnosed with prostate cancer from 2000 to 2003, and we followed them up to 2016.

The important outcome measures are mortality, health resource utilization, cost. Our covariants are marital status, geographic areas, and socioeconomic status. We followed all patients from 2000 to 2016. We have up to 50 ESR for mortality data. To measure the hospital efficiency, we use the data and run an analysis.

It's a popular linear programming method to estimate hospital technical efficiency. We have used 7 input variables, that is number of acute care hospital beds and the number of long‑term hospitals beds, physician, registered nurses, and licensed practice nurses, other clinical labor and nonclinical labor, and finally long‑term care labor.

The 6 hospital outputs used were inpatient days, inpatient care, inpatient surgical procedure, number of outpatient visits, as well as unrelated surgical procedure. The other analysis included Cox regression for survival, and we matched for propensity score for any treatment by us.

Other outcomes variables are 10 year all-cause and prostate cancer specific mortality, health resource utilization, and cost of care. Our analysis showed that controlling for low-quartal efficiency as the efficiency score of hospital increases, there is an increasing trend in reducing the mortality, all costs, prostate cancer specific, as well as ER visit.

In conclusion, if association between efficiency and outcome, outcomes among older prostate cancer patients varied by racial and ethnic group. The higher efficiency was associated with decreased use of hospitalization, ER visits, and cost, as well as association between efficiency and long‑term mortality also varied between racial and ethnic group.

In summary, improved hospital efficiency acts as a protective effect in improving long‑term mortality across all 3 ethnic groups. The policy implications, we need to redirect patients from lower-efficiency hospitals to higher-efficiency hospitals to improve overall quality of care and reduce the cost of care as well.

Thank you.   

Jayadevappa R, Chhatre S, Malkowicz, et al. Hospital efficiency and quality of prostate cancer care. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract 223.

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