Assessing Quality of Colorectal Cancer Care at Commission on Cancer Accredited Hospitals

BACKGROUND: The survival impact of American College of Surgeons Commission on Cancer (CoC) accreditation on colorectal cancer care remains uncertain, particularly when assessed using both outcome-based and process-based quality frameworks. STUDY DESIGN: Hospitals were evaluated using two approaches: an Outcome Method based on 5-year mortality hazard and a Criteria Method based on adherence to evidence-based quality metrics. Data were derived from the National Cancer Database and Centers for Medicare & Medicaid Services. Hospitals were compared by performance tier and CoC accreditation status. RESULTS: Among 1,227 CoC-accredited hospitals, the Outcome Method classified 168 (14%) high-, 861 (70%) medium-, and 198 (16%) low-tier hospitals. Compared with medium-tier hospitals, high-tier hospitals demonstrated lower 5-year mortality hazard (HR 0.63, 95%CI 0.6-0.66), whereas low-tier hospitals had higher hazard (HR 1.51, 95%CI 1.44-1.58). The Criteria Method identified 194 (16%) high-performing and 1,033 (84%) average-performing hospitals; high-performing hospitals had reduced 5-year mortality (HR 0.86, 95%CI 0.81-0.90). Compared with 2,107 non-CoC hospitals, treatment at CoC-accredited hospitals was associated with reduced 1-year mortality using both methods: Outcome Method-high-tier HR 0.81 (95%CI 0.76-0.87), medium-tier HR 0.91 (95%CI 0.87-0.95); Criteria Method-high-performing HR 0.83 (95%CI 0.77-0.88), average-performing HR 0.92 (95%CI 0.88-0.96). CONCLUSIONS: Higher-quality colorectal cancer care, defined by either mortality-based or criteria-based methodologies, is associated with improved survival. CoC accreditation is consistently associated with reduced short-term mortality, supporting its role as a systems-level marker of quality.