Yale Cancer Center Finds Patients Choose Cancer Care Based on Hospital Affiliations
Branding matters when it comes to choosing a hospital, according to a new novel study by Yale Cancer Center (YCC) researchers published in the journal Annals of Surgical Oncology.
After surveying more than 1,000 people about where to receive complex cancer surgery, 85% indicated they would travel one hour to be cared for at a top-ranked hospital specializing in cancer care, rather than stay at a local hospital that was not affiliated with any other hospitals. However, if their local hospital was affiliated with the top-ranked hospital, 31% of people changed their mind and preferred to stay local, suggesting they believed that affiliation with a top-ranked hospital meant that both hospitals (the top-ranked hospital and the affiliate hospitals) offer similar care. To this point, 50% of people indicated that the safety and quality of care was identical at top-ranked hospitals and their affiliate hospitals.
But researchers said these perceptions are problematic. The issue is that while many respondents say they assume the care, safety, and outcomes they would experience at the affiliated local hospital would be the same as at the brand name cancer center, there are no facts that say this is true.
“There is no evidence that the care is the same, and no regulation that governs the advertising and marketing of these affiliations,” said the study’s senior author, Daniel J. Boffa, MD, professor of surgery (thoracic surgery), program leader of the Thoracic Oncology Program at Smilow Cancer Hospital at Yale New Haven, and investigator at Yale’s(COPPER).
The researchers sought to investigate the impact of brand-sharing by surveying, via the web, 1,010 nationally representative adults. Respondents were asked to indicate their hospital preference for complex cancer surgery between the larger top-ranked hospital and a smaller hospital, first in the absence of an affiliation and then in the presence of an affiliation between the two hospitals. When asked to compare leading cancer hospitals and their smaller affiliates:
- 47 percent of respondents felt that surgical safety, 66 percent felt that guideline compliance, and 53 percent felt cure rates would be the same at both hospitals.
- Overall, 47 percent of respondents believed that the surgical care at a top-ranked hospital and its affiliates would be the same across all four safety features (rate of complications, readmissions rate, length of stay and postoperative mortality rate).
- Overall, 44 percent of respondents thought the affiliated hospital would be equivalent in surgical quality standards, including surgical cure rate.
“It is completely understandable that the public would make assumptions that hospitals advertising the same name offer the same care. Some hospital advertising could be even be interpreted as encouraging this line of thinking,” he said. “The truth is that we do not yet know if care received at an affiliated hospital is the same as care at the brand name center, whether that is for complex cancer care or other procedures. Currently hospitals are free to share their brand with almost any hospital they choose. The hospitals are not required to inform patients of any differences in the quality or safety of care provided by the different hospitals within a network. This study suggests that the public is making assumptions in care equality that are potentially influencing their choice for hospital care.”
This confusion about the quality of care in networked hospitals matters because hospitals across the nation are rapidly pairing up together into health care systems, many of which are centered on a prominent hospital whose brand is shared throughout the network. If the care is not equitable, patients may make choices that affect their lives, Boffa added.
“I see these findings as a wake-up call to the medical community to investigate if there are important differences in care between affiliated hospitals and their mother ship, as well as a wake-up call to name brand medical centers to take ownership for outcomes at hospitals that share their names,” he said.
Patients should have access to quality-of-care data in order to make informed decisions, the researchers say.
“What is known is that the issue of where to receive complex cancer care is seen as crucial to patient outcome,” Boffa said. “Studies have found that the quality and safety of such complex cancer care is particularly prone to outcome variability across hospitals, and the risk of dying after an operation can be up to four times greater at hospitals that perform procedures infrequently. Yet other data suggests that, in general, outcomes at top-ranked hospitals can vary widely, and are not always superior to non-ranked hospitals.”
“To our knowledge, this is the first survey to focus on the difference in the public’s perception of care between these two environments, but it is likely that affiliation status and co-branding has already impacted the distribution of patients across the healthcare spectrum,” Boffa said. “The development of affiliations could, potentially, bring cancer expertise closer to patients— but without facts that is just a theory.”
Other study co-authors from Yale: Alexander S. Chin, M.D, M.P.H., Benjamin Resio, M.D., Andres F. Monsalve, M.D., Jessica R. Hoag, Ph.D., Justin D. Blasberg, M.D., Lawrence Brown, M.P.H., Audrey Omar and Marney A. White, Ph.D.