Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor

Accredited Hospitals Linked to Better Rectal Cancer Surgical Outcomes Interview with:

Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor

Alexis G. Antunez

Alexis G. Antunez MS
University of Michigan Medical School, Ann Arbor
Center for Healthcare Outcomes and Policy
University of Michigan, Ann Arbor What is the background for this study?

Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations. What are the main findings? 

Response: In this study we classified hospitals into four groups based on their readiness for accreditation, using validated measures of quality, including surgical volume and adherence to some of the NAPRC rectal cancer process measures. We then compared patient characteristics, hospital characteristics, and outcomes between these hospital groups. What should readers take away from your report?

Response: We found that there is a small group of hospitals prepared for accreditation, and these are predominantly academic centers that serve a highly resourced patient population. We also found that a majority of rectal cancer patients are cared for at low volume or low adherence hospitals, which are most often comprehensive community cancer centers serving patients with fewer socioeconomic resources. The average 5-year survival is lowest among patients in low volume and low adherence hospitals, which are also those hospitals that are least likely to receive accreditation. What recommendations do you have for future research as a result of this work?

Response: There is a risk that, in its current form, the NAPRC may worsen disparities in access to rectal cancer care. The NAPRC should hold institutions to a high standard, however, this should not be at the expense of maintaining access for socioeconomically disadvantaged patients. The NAPRC could preserve access to high quality rectal cancer care via broader accreditation, while still maintaining a commitment to excellence. Deliberate effort to improve the care of underserved populations will likely yield the largest improvements in survival and quality of life for rectal cancer patients. Is there anything else you would like to add?

Response: Future studies should compare metrics of access to care between NAPRC-accredited and non-accredited hospitals. It will also be important to assess the impact of the NARPC’s process measures on outcomes in these patient populations.

Disclosures: This study had no funding and the authors have no conflicts of interest to report. Dr. Regenbogen was supported by a National Institute on Aging Mentored Career Development Award, K08-AG047252. Dr. Kanters was supported by the NIH grant T32 HS000053-24. Ms. Antunez was supported by the NIH grant 1TL1TR002242-01.


Antunez AG, Kanters AE, Regenbogen SE. Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment. JAMA Surg. Published online February 20, 2019. doi:10.1001/jamasurg.2018.5521

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Feb 22, 2019 @ 3:25 am 

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