确定与高质量和低质量多医院系统进行重大癌症手术相关的特征。尽管多医院卫生系统提供了美国大多数住院医疗保健，但我们对这些系统如何优化医院之间的手术质量的了解仍然有限。识别区分高质量和低质量系统的结构特征（例如，医院数量、程序量、地理分散）可能会为提高手术质量的可行策略提供信息。我们对 270,491 名医疗保险受益人进行了一项回顾性横断面观察研究（2016 年） -2020）在多医院卫生系统接受重大癌症手术。根据 30 天死亡率的风险和可靠性调整率，使用分层多变量逻辑回归模型对患者、手术和医院因素进行调整，将系统分为质量四分位数。调整后的 30 天手术死亡率最高- 系统质量最低四分位数分别为 1.7% 和 3.1%（P<0.001）。高质量系统每个系统的医院数量较少（中位数 [IQR]，系统医院数量，5 [3-11] 与 12 [8-30]；P<0.001），每个医院执行的手术数量较多（中位数 [IQR]） IQR] 年手术量，104 [52-218] vs. 45 [22-90]；P<0.001）。高质量系统在地理位置上也更加集中（医院之间的最大距离中位数 [IQR] 分别为 62 [19-194] 英里和 321 [91-1125] 英里；P<0.001）。此外，高质量系统表现出医院之间的质量差异较小（平均 [SD] 系统内死亡率绝对差异，0.8% [0.3%] 与 2.6% [1.0%]；P<0.001）。多医院系统的医院数量更少、地理位置更集中，每家医院执行的手术更多。在最高质量的系统中，代表了不同的系统表型，这表明克服结构限制并实现高质量的潜力。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To identify characteristics associated with high- and low-quality multi-hospital systems for major cancer surgery.Although multi-hospital health systems provide most inpatient healthcare in the US, our understanding of how these systems can optimize surgical quality among their hospitals remains limited. Identifying the structural characteristics (e.g., number of hospitals, procedural volume, geographic dispersion) that distinguish high- and low-quality systems may inform actionable strategies to improve surgical quality.We conducted a retrospective cross-sectional observational study of 270,491 Medicare beneficiaries (2016-2020) undergoing major cancer surgery at a multi-hospital health system. Systems were classified into quartiles of quality based on risk- and reliability-adjusted rates of 30-day mortality using a hierarchical multivariable logistical regression model to adjust for patient, procedural, and hospital factors.The adjusted 30-day operative mortality rate in the highest- versus lowest-quality quartile of systems was 1.7% versus 3.1%,(P<0.001). High-quality systems had fewer hospitals per system (median [IQR], number of system hospitals, 5 [3-11] vs. 12 [8-30];P<0.001), with each performing more procedures per hospital (median [IQR] annual procedure volume, 104 [52-218] vs. 45 [22-90];P<0.001). High-quality systems were also more geographically concentrated (median [IQR] maximum distance between hospitals, 62 [19-194] vs. 321 [91-1125] miles;P<0.001). Furthermore, high-quality systems demonstrated less variation in quality between hospitals (mean [SD] within-system absolute variation in mortality, 0.8% [0.3%] vs. 2.6% [1.0%];P<0.001).The highest-quality multi-hospital systems had fewer, more geographically concentrated hospitals, with each performing more procedures per hospital. Among the highest-quality systems, diverse system phenotypes were represented, suggesting the potential to overcome structural limitations and achieve high quality.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.