Grant Number:	1R01CA098481-01A1 Interpret this number
Primary Investigator:	Birkmeyer, John
Organization:	Dartmouth College
Project Title:	Structure, Process, and Outcomes in Cancer Surgery
Fiscal Year:	2003

DESCRIPTION (provided by applicant): Cancer surgery is associated with high operative mortality rates, particularly at hospitals with low procedure volumes. Efforts to improve quality at these centers are hindered by lack of understanding about mechanisms responsible for observed volume-outcome relationships. This study will approach this question in 3 steps: 1. Determine what's different between high volume and low volume hospitals. Using 100% national samples from the 1994-2001 Medicare database (n approximately 800,000), we will compare structure and process variables at high and low volume hospitals with each of 8 procedures. Structural variables specific to cancer care will include on-site availability of radiation and chemotherapy services, hospital participation in cancer trials, and surgeon "specialization" in cancer surgery. We will then assess variables related to patient selection and other processes of perioperative care. 2. Identify, which factors help explain observed volume-outcome relationships. We will then examine relationships between structure, process, and outcomes (operative mortality) with the 8 procedures. Using nested models, we will assess how observed volume-outcome relationships change as various structural and process of care variables are added to the model. We will repeat these analyses using the SEER-Medicare linked database to better control for case-mix (tumor stage). 3. Prepare the groundwork for studying the fine details of care. To best plan a study of structure, process, and outcomes based on medical records or site visits, we must first understand whether variation in operative mortality rates across hospitals is attributable to specific causes of death. We will develop and test a chart-based instrument for assessing cause of death in a pilot study at two hospitals in northern New England.




Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.
Authors: Scally C.P. , Yin H. , Birkmeyer J.D. , Wong S.L. .
Source: Journal Of Surgical Oncology, 2015 Dec; 112(8), p. 866-71.
PMID: 26593455
Related Citations

Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.
Authors: Grenda T.R. , Revels S.L. , Yin H. , Birkmeyer J.D. , Wong S.L. .
Source: Jama Surgery, 2015 Nov; 150(11), p. 1034-40.
PMID: 26267440
Related Citations

Variation in hospital mortality rates with inpatient cancer surgery.
Authors: Wong S.L. , Revels S.L. , Yin H. , Stewart A.K. , McVeigh A. , Banerjee M. , Birkmeyer J.D. .
Source: Annals Of Surgery, 2015 Apr; 261(4), p. 632-6.
PMID: 24743604
Related Citations

Differences in perioperative care at low- and high-mortality hospitals with cancer surgery.
Authors: Revels S.L. , Wong S.L. , Banerjee M. , Yin H. , Birkmeyer J.D. .
Source: Annals Of Surgical Oncology, 2014 Jul; 21(7), p. 2129-35.
PMID: 24710775
Related Citations

Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue.
Authors: Gonzalez A.A. , Dimick J.B. , Birkmeyer J.D. , Ghaferi A.A. .
Source: Jama Surgery, 2014 Feb; 149(2), p. 119-23.
PMID: 24336902
Related Citations

Hospital volume and failure to rescue with high-risk surgery.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: Medical Care, 2011 Dec; 49(12), p. 1076-81.
PMID: 22002649
Related Citations

Racial disparities in the use of revascularization before leg amputation in Medicare patients.
Authors: Holman K.H. , Henke P.K. , Dimick J.B. , Birkmeyer J.D. .
Source: Journal Of Vascular Surgery, 2011 Aug; 54(2), p. 420-6, 426.e1.
PMID: 21571495
Related Citations

Hospital process compliance and surgical outcomes in medicare beneficiaries.
Authors: Nicholas L.H. , Osborne N.H. , Birkmeyer J.D. , Dimick J.B. .
Source: Archives Of Surgery (chicago, Ill. : 1960), 2010 Oct; 145(10), p. 999-1004.
PMID: 20956770
Related Citations

Hospital characteristics associated with failure to rescue from complications after pancreatectomy.
Authors: Ghaferi A.A. , Osborne N.H. , Birkmeyer J.D. , Dimick J.B. .
Source: Journal Of The American College Of Surgeons, 2010 Sep; 211(3), p. 325-30.
PMID: 20800188
Related Citations

Racial differences in treatment and outcomes among patients with early stage bladder cancer.
Authors: Hollenbeck B.K. , Dunn R.L. , Ye Z. , Hollingsworth J.M. , Lee C.T. , Birkmeyer J.D. .
Source: Cancer, 2010-01-01 00:00:00.0; 116(1), p. 50-6.
PMID: 19877112
Related Citations

Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: Annals Of Surgery, 2009 Dec; 250(6), p. 1029-34.
PMID: 19953723
Related Citations

Variation in hospital mortality associated with inpatient surgery.
Authors: Ghaferi A.A. , Birkmeyer J.D. , Dimick J.B. .
Source: The New England Journal Of Medicine, 2009-10-01 00:00:00.0; 361(14), p. 1368-75.
PMID: 19797283
Related Citations

Provider treatment intensity and outcomes for patients with early-stage bladder cancer.
Authors: Hollenbeck B.K. , Ye Z. , Dunn R.L. , Montie J.E. , Birkmeyer J.D. .
Source: Journal Of The National Cancer Institute, 2009-04-15 00:00:00.0; 101(8), p. 571-80.
EPub date: 2009-04-15 00:00:00.0.
PMID: 19351919
Related Citations

Improving outcomes with lung cancer surgery: selective referral or quality improvement?
Authors: Birkmeyer J.D. .
Source: Annals Of Surgical Oncology, 2009 Jan; 16(1), p. 1-2.
PMID: 18989723
Related Citations

Hospital lymph node counts and survival after radical cystectomy.
Authors: Hollenbeck B.K. , Ye Z. , Wong S.L. , Montie J.E. , Birkmeyer J.D. .
Source: Cancer, 2008-02-15 00:00:00.0; 112(4), p. 806-12.
PMID: 18085612
Related Citations

Outcomes after transhiatal and transthoracic esophagectomy for cancer.
Authors: Chang A.C. , Ji H. , Birkmeyer N.J. , Orringer M.B. , Birkmeyer J.D. .
Source: The Annals Of Thoracic Surgery, 2008 Feb; 85(2), p. 424-9.
PMID: 18222237
Related Citations

Outcomes in octogenarians undergoing high-risk cancer operation: a national study.
Authors: Finlayson E. , Fan Z. , Birkmeyer J.D. .
Source: Journal Of The American College Of Surgeons, 2007 Dec; 205(6), p. 729-34.
PMID: 18035254
Related Citations

Hospital lymph node examination rates and survival after resection for colon cancer.
Authors: Wong S.L. , Ji H. , Hollenbeck B.K. , Morris A.M. , Baser O. , Birkmeyer J.D. .
Source: Jama : The Journal Of The American Medical Association, 2007-11-14 00:00:00.0; 298(18), p. 2149-54.
PMID: 18000198
Related Citations

Hospital volume and late survival after cancer surgery.
Authors: Birkmeyer J.D. , Sun Y. , Wong S.L. , Stukel T.A. .
Source: Annals Of Surgery, 2007 May; 245(5), p. 777-83.
PMID: 17457171
Related Citations

Volume, process of care, and operative mortality for cystectomy for bladder cancer.
Authors: Hollenbeck B.K. , Wei Y. , Birkmeyer J.D. .
Source: Urology, 2007 May; 69(5), p. 871-5.
PMID: 17482924
Related Citations

Use of adjuvant radiotherapy at hospitals with and without on-site radiation services.
Authors: Wong S.L. , Wei Y. , Birkmeyer J.D. .
Source: Cancer, 2007-02-15 00:00:00.0; 109(4), p. 796-801.
PMID: 17211840
Related Citations

Racial disparities in late survival after rectal cancer surgery.
Authors: Morris A.M. , Wei Y. , Birkmeyer N.J. , Birkmeyer J.D. .
Source: Journal Of The American College Of Surgeons, 2006 Dec; 203(6), p. 787-94.
PMID: 17116545
Related Citations

Classifying cause of death after cancer surgery.
Authors: Waljee J.F. , Windisch S. , Finks J.F. , Wong S.L. , Birkmeyer J.D. .
Source: Surgical Innovation, 2006 Dec; 13(4), p. 274-9.
PMID: 17227926
Related Citations

Volume and process of care in high-risk cancer surgery.
Authors: Birkmeyer J.D. , Sun Y. , Goldfaden A. , Birkmeyer N.J. , Stukel T.A. .
Source: Cancer, 2006-06-01 00:00:00.0; 106(11), p. 2476-81.
PMID: 16634089
Related Citations

Specialty training and mortality after esophageal cancer resection.
Authors: Dimick J.B. , Goodney P.P. , Orringer M.B. , Birkmeyer J.D. .
Source: The Annals Of Thoracic Surgery, 2005 Jul; 80(1), p. 282-6.
PMID: 15975382
Related Citations

Do cancer centers designated by the National Cancer Institute have better surgical outcomes?
Authors: Birkmeyer N.J. , Goodney P.P. , Stukel T.A. , Hillner B.E. , Birkmeyer J.D. .
Source: Cancer, 2005-02-01 00:00:00.0; 103(3), p. 435-41.
PMID: 15622523
Related Citations

Measuring the quality of surgical care: structure, process, or outcomes?
Authors: Birkmeyer J.D. , Dimick J.B. , Birkmeyer N.J. .
Source: Journal Of The American College Of Surgeons, 2004 Apr; 198(4), p. 626-32.
PMID: 15051016
Related Citations