title: Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study.
abstract: The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation.
  
  
  
  Women who were diagnosed with stage I-III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy).
  
  
  
  Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high-, medium-, and low-volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05-1.25; high volume: OR = 1.30, 95% CI = 1.14-1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06-1.24; high volume: OR = 1.28, 95% CI = 1.13-1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07-1.17; high volume: OR = 1.16, 95% CI = 1.09-1.24).
  
  
  
  Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume-survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957-66. © 2016 American Cancer Society.
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.|Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Liliana E
authors.initials: LE
authors.lastname: Pezzin
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jianing
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Rodney
authors.initials: R
authors.lastname: Sparapani
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Purushuttom W
authors.initials: PW
authors.lastname: Laud
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003695:Delivery of Health Care; D019468:Disease Management; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology
keywords: National Cancer Data Base; breast cancer; chemotherapy; hormonal therapy; hospital volume; processes of care; radiation therapy; surgical margins