Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality.
Most patients, providers, and payers make decisions about cancer hospitals without any objective data regarding quality or outcomes. We developed two online resources allowing users to search and compare timely data regarding hospital cancer surgery volumes.



Hospital cancer surgery volumes for all California hospitals were calculated using ICD-9 coded hospital discharge summary data. Cancer surgeries included (bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach) were selected on the basis of a rigorous literature review to confirm sufficient evidence of a positive association between volume and mortality. The literature could not identify threshold numbers of surgeries associated with better or worse outcomes. A multidisciplinary working group oversaw the project and ensured sound methodology.



In California in 2014, about 60% of surgeries were performed at top-quintile-volume hospitals, but the per-hospital median numbers of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries were four or fewer. At least 670 patients received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer type; 72% of those patients lived within 50 miles of a top-quintile-volume hospital.



There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Christina A
CA
Clarke
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Steven M
SM
Asch
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Laurence
L
Baker
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Karl
K
Bilimoria
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
R Adams
RA
Dudley
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Niya
N
Fong
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Merry L
ML
Holliday-Hanson
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
David S P
DS
Hopkins
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Elizabeth M
EM
Imholz
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Jennifer
J
Malin
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Lisa
L
Moy
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Maryann
M
O'Sullivan
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Joseph P
JP
Parker
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Christopher S
CS
Saigal
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Bruce
B
Spurlock
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Stephanie
S
Teleki
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
David
D
Zingmond
Cancer Prevention Institute of California, Fremont; Stanford University, Stanford; University of California, Pacific Business Group on Health, and Consumers Union of US, San Francisco; California Office of Statewide Health Planning and Development, and Covered California, Sacramento; Anthem, Woodland Hills; University of California, Los Angeles; California Health Care Foundation, Oakland; and Independent Health Policy Consultant, Berkeley, CA; Northwestern University, Chicago, IL; and Cynosure Health, Westford, MA.
Lance
L
Lang
D002140:California; D003657:Decision Making; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000601:surgery*; D011787:Quality of Health Care