title: "Lumping" vs "splitting" in oncologic pathology: association with cancer center type and case volume.
abstract: BACKGROUND
  Prior studies reported associations of cancer center facility type and case volume with cancer outcomes (such as survival) and treatment-related processes (such as treatment with chemotherapy, surgery, or radiotherapy).
  
  
  OBJECTIVE
  To determine whether facility characteristics are associated with use of broad (lumped) vs narrow (split) diagnoses in cancer pathology.
  
  
  METHODS
  We examined associations of facility characteristics and prevalence of broad diagnoses that might adversely affect treatment decisions (based on National Comprehensive Cancer Network treatment guidelines) in National Cancer Data Base records for patients diagnosed from 2004-2008. Logistic regression was used to determine whether associations of facility type and volume with prevalence of broad diagnoses were independent of patient demographic/socioeconomic factors.
  
  
  RESULTS
  Among 10 high incidence cancer sites, 5 had a prevalence of broad diagnoses exceeding 6%. For 4 of these, use of broad diagnoses was independently lower in NCI (National Cancer Institute)- designated comprehensive programs than in community programs, with multivariate prevalence ratios (PR) as low as 0.46 (95% confidence interval [CI] 0.35-0.59) for uterine corpus cancers and 0.49 (95% CI 0.44-0.55) for kidney and renal pelvis cancers. Differences between low- and high-volume facilities were observed for 4 of the 5 sites, with multivariate PR as low as 0.67 (95% CI 0.59-0.77) and 0.72 (95% CI 0.63-0.82) for cancers of the uterine corpus and lung, respectively.
  
  
  CONCLUSIONS
  Prevalence of broad cancer diagnoses varies independently by cancer site/type, facility type, and facility volume. Broader diagnoses tend to be used most often by community cancer centers and low-volume centers. This association has implications for use of registry data in pathology quality assessment and quality improvement.
authors.forename: Ted
authors.initials: T
authors.lastname: Gansler
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Fedewa
authors.forename: Dana
authors.initials: D
authors.lastname: Flanders
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D003430:Cross-Sectional Studies; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D010338:Pathology, Clinical / Q000379:methods*; D012042:Registries / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States