Evidence-aligned surgical cancer care at hub versus spoke hospitals of multihospital systems

BACKGROUND: Most surgical cancer care is provided in health systems, which vary in quality and in how services are distributed across system hospitals. The study objective was to compare quality of care based on provision of evidence-aligned care (EAC) for patients with common cancers treated at hub versus spoke hospitals in centralized and de-centralized health systems. STUDY DESIGN: This retrospective cohort study evaluated SEER Medicare patients with breast, prostate, melanoma, or thyroid cancer from 2008-2018 who were treated in multihospital systems. Using mixed effects models, care at hubs of systems with a high degree of centralization was compared to care at hubs of de-centralized systems and system spokes. RESULTS: Among 99,227 cancer cases treated at 1,023 hospitals in 191 health systems, adherence to EAC was 70.9% with a bimodal distribution by practice (highly adopted practices had 77.4% adherence; poorly adopted practices had 29.9% adherence). For highly adopted practices there was no difference in adherence based on treatment in a hub versus spoke hospital. For poorly adopted practices, patients treated at hubs of centralized systems were more likely to have evidence-aligned care than patients treated at spoke hospitals (Odds Ratio 0.804, 95% Confidence Interval 0.648-0.998). CONCLUSIONS: For evidence-based practices with overall low adoption, patients treated at spoke hospitals were less likely to receive evidence-aligned care than those treated at centralized hubs. Systems should consider centralizing care at hubs or disseminating hub expertise and practices to spoke sites to improve overall quality of care.