Palacios DA, Wilson B, Michael P et al: A novel metric for hospital quality in kidney cancer surgery: a veterans affairs national health system validation of concept. Urol Pract 2021; https://doi.org/10.1097/UPJ.0000000000000294.

Study Need and Importance

Development and implementation of quality metrics to assess the surgical care performance of hospitals treating patients with kidney cancer are crucial, especially in the setting of large and geographically diverse health care systems such as Veterans Affairs (VA). In this study we developed a Compound Quality Score (CQS) to serve as a metric for hospital-level quality of care in kidney cancer surgery.

What We Found

We found that our CQS was able to discriminate hospital performance in kidney cancer surgical care across the VA health care system (see figure). Importantly, even after rigorous hospital-level case-mix adjustment, higher quality scores were independently associated with reduced length of stay, lower rates of postoperative surgical and medical complications, and lower cost of surgical admission.

Figure. Hospital performance per CQS across the VA National Health System. CQS identified 25 hospitals (26%) with higher performance (CQS ≥1), 33 hospitals (34%) with lower performance (CQS≤ −1) and 38 hospitals (39%) with average performance (CQS=0).

Limitations

The major limitation of this study is the lack of external validation, and therefore applicability of this metric outside the VA health system needs to be established. In addition, our CQS does not identify the root cause of inferior perioperative outcomes. Site-specific quality improvement strategies are required to elucidate these causes and target areas for improvement.

Interpretation for Patient Care

Variability in quality of surgical care at hospitals treating patients with kidney cancer can be captured with this novel approach. Quality metrics such as the CQS should be used to identify, audit and implement quality improvement strategies across health systems.