Journal of the American College of Surgeons · 2026
Assessing Quality of Colorectal Cancer Care at Commission on Cancer-Accredited Hospitals.
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Cotler Joseph H, Sachs Amy J, Browner Amanda E, Sala Cassandra, Zhu Xuan, Palis Bryan, Turner Patricia L, Ko Clifford Y, Weigel Ronald J
Аннотация
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 2 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 the Centers for Medicare and 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 (hazard ratio [HR] 0.63, 95% CI 0.6 to 0.66), whereas low-tier hospitals had higher hazard (HR 1.51, 95% CI 1.44 to 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 to 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 to 0.87), medium-tier HR 0.91 (95% CI 0.87 to 0.95); criteria method-high-performing HR 0.83 (95% CI 0.77 to 0.88), average-performing HR 0.92 (95% CI 0.88 to 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 system-level marker of quality.
STUDY DESIGN: Hospitals were evaluated using 2 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 the Centers for Medicare and 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 (hazard ratio [HR] 0.63, 95% CI 0.6 to 0.66), whereas low-tier hospitals had higher hazard (HR 1.51, 95% CI 1.44 to 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 to 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 to 0.87), medium-tier HR 0.91 (95% CI 0.87 to 0.95); criteria method-high-performing HR 0.83 (95% CI 0.77 to 0.88), average-performing HR 0.92 (95% CI 0.88 to 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 system-level marker of quality.