National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedBonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Medbery RL, Fernandez FG, Kosinski AS
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Researchers sought to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer. Using the Society of Thoracic Surgeons General Thoracic Surgery Database, they found that lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
AHRQ-funded; R01 HS022279.
Citation: Medbery RL, Fernandez FG, Kosinski AS .
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Ann Thorac Surg 2021 Jun;111(6):1781-90. doi: 10.1016/j.athoracsur.2020.08.073..
Keywords: Cancer: Lung Cancer, Cancer, Healthcare Costs, Surgery, Elderly, Medicare
Cowper PA, Feng L, Kosinski AS
Initial and longitudinal cost of surgical resection for lung cancer.
This study looked at the 4-year longitudinal cost of surgical resection of non-small cell lung cancer (NSCLC). The study describes initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or older who were treated surgically from 2008 to 2013. Clinical data for NSCLC resections from The Society of Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined. Outcomes were stratified by pathologic stage and surgical approach for stage I lobectomy patients. In the first 90 days costs ranged from $12,430 for stage I to $26,350 for stage IV. Cumulative costs ranged from $131,032 for stage I to $205,368 for stage IV. For the stage I lobectomy cohort, patients who had minimally invasive procedures had lower 4-year costs than thoracotomy patients ($120,346 versus $136,250).
AHRQ-funded; R01 HS022279.
Citation: Cowper PA, Feng L, Kosinski AS .
Initial and longitudinal cost of surgical resection for lung cancer.
Ann Thorac Surg 2021 Jun;111(6):1827-33. doi: 10.1016/j.athoracsur.2020.07.048..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Healthcare Costs
Onaitis MW, Furnary AP, Kosinski AS
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
This study compared the effectiveness of lobectomy and segmentectomy for treatment of clinical stage IA (T1N0) lung cancer patients. The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) from 2002 to 2015. Survival rates were found to be similar.
AHRQ-funded; HS022279.
Citation: Onaitis MW, Furnary AP, Kosinski AS .
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
Ann Thorac Surg 2020 Dec;110(6):1882-91. doi: 10.1016/j.athoracsur.2020.01.020..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Herb JN, Dunham LN, Mody G
Lung cancer surgical regionalization disproportionately worsens travel distance for rural patients.
Researchers hypothesized that lung cancer patients have been traveling further for surgery over time as regionalization has occurred, and this increased travel has primarily impacted rural patients. Using data from a North Carolina all-payer state discharge database, they found that the number of hospitals performing lung cancer resections decreased from 49 to 31 over the study period, and the proportion of patients receiving care at high-volume centers increased. Rural patient travel distance increased over time by 8.5 miles, with no change in urban patient travel distance. They concluded that, in North Carolina, lung cancer surgical regionalization occurred over the study period and was accompanied by increases in travel distance for rural patients only. They recommended further work to determine the effects of greater travel distance on patterns of cancer care for rural patients.
AHRQ-funded; HS000032.
Citation: Herb JN, Dunham LN, Mody G .
Lung cancer surgical regionalization disproportionately worsens travel distance for rural patients.
J Rural Health 2020 Sep;36(4):496-505. doi: 10.1111/jrh.12440..
Keywords: Cancer: Lung Cancer, Cancer, Rural Health, Surgery, Access to Care
Ezer N, Mhango G, Bagiella E
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
This study examined racial disparities in resection surgery of non-small cell lung cancer (NSCLC). These disparities are well documented. The authors identified 19,624 patients with stage I-II NSCLC 65 years and older from the SEER-Medicare database. They studied patients evaluated by a surgeon within 6 months of diagnosis. Black patients were less likely to undergo resection with resection rates varying among surgeons. Thoracic surgeon specialists were less likely to have any disparities with resection rates.
AHRQ-funded; HS019670.
Citation: Ezer N, Mhango G, Bagiella E .
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
Med Care 2020 Apr;58(4):392-98. doi: 10.1097/mlr.0000000000001280..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Practice Patterns
Wang S, Lai S, von Itzstein MS
Type and case volume of health care facility influences survival and surgery selection in cases with early-stage non-small cell lung cancer.
With the expansion of non-small cell lung cancer (NSCLC) screening methods, the percentage of cases with early-stage NSCLC is anticipated to increase. Yet it remains unclear how the type and case volume of the health care facility at which treatment occurs may affect surgery selection and overall survival for cases with early-stage NSCLC. In this study, the investigators examine how type and case volume of health care facility influenced survival and surgery selection in cases with early-stage non-small cell lung cancer.
AHRQ-funded; HS022418.
Citation: Wang S, Lai S, von Itzstein MS .
Type and case volume of health care facility influences survival and surgery selection in cases with early-stage non-small cell lung cancer.
Cancer 2019 Dec 1;125(23):4252-59. doi: 10.1002/cncr.32377..
Keywords: Cancer: Lung Cancer, Surgery, Cancer, Patient-Centered Outcomes Research, Outcomes, Mortality
Fernandez FG, Kosinski AS, Tong BC
Lack of correlation between short- and long-term performance after lung cancer surgery.
In this study, the investigators examined correlation between measures of short-term and long-term performance for lung cancer surgery. The investigators concluded that avoidance of perioperative morbidity and mortality is an incomplete measure of performance in lung cancer surgery. They suggest that lung cancer surgery performance metrics should assess the safety of surgery and long-term survival.
AHRQ-funded; HS022279.
Citation: Fernandez FG, Kosinski AS, Tong BC .
Lack of correlation between short- and long-term performance after lung cancer surgery.
J Thorac Cardiovasc Surg 2019 Apr;157(4):1633-43.e3. doi: 10.1016/j.jtcvs.2018.09.141..
Keywords: Cancer, Cancer: Lung Cancer, Outcomes, Surgery
Tong BC, Kim S, Kosinski A
Penetration, completeness, and representativeness of the Society of Thoracic Surgeons General Thoracic Surgery Database for lobectomy.
Not all surgeons performing lobectomy in the United States report outcomes to The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). In this study, the investigators examined penetration, completeness, and representativeness of the STS GTSD for lobectomy in the Centers for Medicare and Medicaid Services (CMS) patient population. The investigators concluded that participation in the STS GTSD increased over time, but penetration lagged behind that of the other STS National Databases.
AHRQ-funded; HS022279.
Citation: Tong BC, Kim S, Kosinski A .
Penetration, completeness, and representativeness of the Society of Thoracic Surgeons General Thoracic Surgery Database for lobectomy.
Ann Thorac Surg 2019 Mar;107(3):897-902. doi: 10.1016/j.athoracsur.2018.07.059..
Keywords: Surgery, Cancer: Lung Cancer, Cancer, Data, Provider: Physician, Provider
Boffa DJ, Kosinski AS, Furnary AP
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
The study authors hypothesized that the minimally invasive video-assisted thoracic surgery (VATS) approach to lobectomy for stage I lung cancer resulted in a longitudinal outcome that was not inferior to thoracotomy. After conducting their study, they concluded that the long-term efficacy of lobectomy for stage I lung cancer performed using the VATS approach by board-certified thoracic surgeons does not seem to be inferior to that of thoracotomy.
AHRQ-funded; HS022279.
Citation: Boffa DJ, Kosinski AS, Furnary AP .
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
J Clin Oncol 2018 Aug 10;36(23):2378-85. doi: 10.1200/jco.2018.77.8977..
Keywords: Cancer: Lung Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Ezer N, Kale M, Sigel K
Outcomes after video-assisted thoracoscopic lobectomy versus open lobectomy for early-stage lung cancer in older adults.
This study evaluated whether the improved perioperative outcomes associated with video-assisted thoracoscopic surgery (VATS) lobectomy are explained by surgeon characteristics, including case volume and specialty training. It concluded that VATS lobectomy for non-small cell lung cancer (NSCLC) is associated with better postoperative outcomes, but similar long-term survival, compared with open lobectomy among older adults, even after controlling for surgeon experience.
AHRQ-funded; HS019670.
Citation: Ezer N, Kale M, Sigel K .
Outcomes after video-assisted thoracoscopic lobectomy versus open lobectomy for early-stage lung cancer in older adults.
Ann Am Thorac Soc 2018 Jan;15(1):76-82. doi: 10.1513/AnnalsATS.201612-980OC.
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Keywords: Comparative Effectiveness, Elderly, Cancer: Lung Cancer, Surgery
Boffa D, Fernandez FG, Kim S
Surgically managed clinical stage iiia-clinical n2 lung cancer in the Society of Thoracic Surgeons Database.
The objective of this study was to characterize the management of clinical stage IIIA-N2 positive (cIIIA-N2) lung cancer in The Society of Thoracic Surgeons General Thoracic Surgery Database. Surgeons achieved excellent short- and long-term results treating predominantly lobectomy-amenable cIIIA-N2 lung cancer. However, prevalent overstaging and abstention from induction therapy suggested "overcoding" of false positives on imaging or variable compliance with current guidelines for cIIIA-N2 lung cancer.
AHRQ-funded; HS022279.
Citation: Boffa D, Fernandez FG, Kim S .
Surgically managed clinical stage iiia-clinical n2 lung cancer in the Society of Thoracic Surgeons Database.
Ann Thorac Surg 2017 Aug;104(2):395-403. doi: 10.1016/j.athoracsur.2017.02.031.
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Keywords: Surgery, Cancer: Lung Cancer, Registries, Elderly, Outcomes
Fernandez FG, Kosinski AS, Burfeind W
The Society of Thoracic Surgeons lung cancer resection risk model: higher quality data and superior outcomes.
The researchers updated the lung cancer resection risk model utilizing the Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) with a larger and more contemporary cohort. Risk factors from the prior lung cancer resection model were refined, and new risk factors such as prior thoracic surgery were identified. They concluded that operative mortality and complication rates were low for lung cancer resection among surgeons participating in the GTSD.
AHRQ-funded; HS022279.
Citation: Fernandez FG, Kosinski AS, Burfeind W .
The Society of Thoracic Surgeons lung cancer resection risk model: higher quality data and superior outcomes.
Ann Thorac Surg 2016 Aug;102(2):370-7. doi: 10.1016/j.athoracsur.2016.02.098.
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Keywords: Cancer: Lung Cancer, Risk, Surgery, Patient Safety
Fernandez FG, Furnary AP, Kosinski AS
Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery Database in patients 65 years and older.
The purpose of this paper was to provide longitudinal follow-up to the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) through linkage to the Centers for Medicare and Medicaid Services (CMS) data for patients 65 years of age or older. The researchers found that median survival after lung cancer resection was 6.7 years for pathologic stage I, 3.5 years for stage II, 2.4 years for stage III, and 2.2 years for stage IV. They concluded that CMS data complement the STS GTSD data by enabling examination of long-term survival and resource utilization in patients 65 years or older.
AHRQ-funded; HS022279.
Citation: Fernandez FG, Furnary AP, Kosinski AS .
Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery Database in patients 65 years and older.
Ann Thorac Surg 2016 Jun;101(6):2067-76. doi: 10.1016/j.athoracsur.2016.03.034.
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Keywords: Cancer: Lung Cancer, Surgery, Elderly, Outcomes, Mortality
Rajaram R, Paruch JL, Mohanty S
Patterns and predictors of chemotherapy use for resected non-small cell lung cancer.
The researchers sought to evaluate chemotherapy use in resected stage IB to IIIA non-small cell lung cancer (NSCLC) over time and to identify predictors of perioperative chemotherapy administration. They found that the use of chemotherapy has significantly increased in patients with resected stage IB to IIIA NSCLC.
AHRQ-funded; HS000078.
Citation: Rajaram R, Paruch JL, Mohanty S .
Patterns and predictors of chemotherapy use for resected non-small cell lung cancer.
Ann Thorac Surg 2016 Feb;101(2):533-40. doi: 10.1016/j.athoracsur.2015.08.077..
Keywords: Treatments, Cancer: Lung Cancer, Surgery, Outcomes, Quality Improvement
Grenda TR, Revels SL, Yin H
Lung cancer resection at hospitals with high vs low mortality rates.
The objective of this study was to evaluate perioperative outcomes in patients who underwent lung cancer resection at high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) in order to better understand the factors related to differences in mortality rates after lung cancer resection. It concluded that failure-to-rescue rates are higher at HMHs, which may explain the large differences between hospitals in mortality rates following lung cancer resection.
AHRQ-funded; HS000053; HS020937.
Citation: Grenda TR, Revels SL, Yin H .
Lung cancer resection at hospitals with high vs low mortality rates.
JAMA Surg 2015 Nov;150(11):1034-40. doi: 10.1001/jamasurg.2015.2199..
Keywords: Cancer: Lung Cancer, Surgery, Mortality, Outcomes, Patient Safety
Veluswamy RR, Ezer N, Mhango G
Limited resection versus lobectomy for older patients with early-stage lung cancer: Impact of histology.
The researchers used population-based data to assess the equivalency of limited resection versus lobectomy among older patients with stage IA invasive adenocarcinoma and squamous cell carcinoma less than 2 cm in size. They found generally that limited resection is not equivalent to lobectomy in older patients with invasive non–small-cell lung cancer, although segmentectomy may be equivalent in patients with adenocarcinoma.
AHRQ-funded; HS019670.
Citation: Veluswamy RR, Ezer N, Mhango G .
Limited resection versus lobectomy for older patients with early-stage lung cancer: Impact of histology.
J Clin Oncol 2015 Oct 20;33(30):3447-53. doi: 10.1200/jco.2014.60.6624..
Keywords: Cancer, Cancer: Lung Cancer, Comparative Effectiveness, Surgery