Hospitals' Web Site Lists of Their Interventional Pain Procedures Inadequately Reflect the Diversity of Their Actual Pain Medicine Practices.

BACKGROUND: Multidisciplinary chronic pain management includes many types of interventional pain procedures. However, navigating the landscape of providers offering such services is challenging. OBJECTIVE: We investigated whether stakeholders (e.g., patients, referring physicians, hospital administrators, nurses working for insurance companies, and state officials) could accurately judge the diversity of interventional services actually provided based on information gathered from hospital Web sites. STUDY DESIGN: This was an observational cohort study. SETTING: All 119 nonfederal hospitals in Iowa were included in the study. METHODS: We recorded the publicly available data presented on all hospital Web pages related to interventional pain procedures. We counted the listed types of procedures and numbers of pain medicine physicians portrayed. We compared those results with actual performed interventional pain procedures calculated using contemporaneous data from the Iowa Hospital Association. The diversity of types of procedures performed was quantified using the inverse of the Herfindahl index. RESULTS: No pain medicine physician was identified on the Web site for 87.4% of hospitals. Such hospitals accounted for 61.4% of the interventional pain procedures performed statewide. The partial Kendall correlation between the count of types of procedures listed on Web sites and the number of pain medicine physicians, controlling for the performed procedures during the year, was too small to be informative: 0.22 (95% Confidence Interval [CI], 0.07 to 0.38; P = .005). The one-sided upper confidence limit that included 0.50 (i.e., moderate) was the 99.98% limit. The partial correlation between the count of types of procedures listed on Web sites and the actual diversity of types of procedures performed, controlling for the performed procedures during the year, was not statistically significant: 0.12 (95% CI, -0.03 to 0.28; P = .12). The partial Kendall correlation between the number of pain medicine physicians listed on the Web sites and the diversity of types of procedures performed was not significant: 0.03 (95% CI, -0.13 to 0.19; P = .73). LIMITATIONS: This study was limited to the state of Iowa, where we found that 38.6% of interventional pain procedures were performed at hospitals with at least one pain medicine physician. The 38.6% is substantively less than the corresponding estimate of 54.2% for the state of Florida. The estimate of 38.6% exceeds the estimate of 30.4% for critical access hospitals in the United States nationwide. Although the heterogeneity is as expected, it shows that findings are likely to be heterogeneous across regions. CONCLUSIONS: Stakeholders could not have accurate awareness of the spectrum of services provided by multidisciplinary pain medicine clinics and physicians based on currently reported data, even if they sought it out from publicly available information. Transparency will need to come from pain medicine physicians, at facilities providing the full diversity of services, releasing quantitative data about the services that they provide (e.g., counts by procedure).

Improved survival for extremity soft tissue sarcoma treated in high-volume facilities.

BACKGROUND AND OBJECTIVES: The purpose of this investigation was to determine the effect of hospital volume on treatment decisions, treatment results, and overall patient survival in extremity soft tissue sarcoma. METHODS: The National Cancer Database was used to identify patients ≥18 years of age with non-metastatic soft tissue sarcoma of the extremity treated with surgery. Patients in high- and low-volume centers were matched by propensity score and placed into two equal comparative groups of 2437 patients each. RESULTS: Chemotherapy was used at a higher rate in high-volume centers (22% vs 17%, P < 0.001) and external beam radiation usage was similar (55% vs 52%, P = 0.108). There was a lower incidence of positive margins in high-volume centers (12% vs 17%, P < 0.001). There was no significant difference in the rates of limb salvage surgery or readmissions at high-volume hospitals compared to low-volume. In a multivariate Cox proportional hazards model, low-volume facilities demonstrated diminished overall survival at all time points (hazard ratio at 5 years = 1.24, 95%CI 1.10-1.39). CONCLUSIONS: Treatment at high-volume hospitals was associated with fewer positive margins and increased overall survival at 2, 5, and 10 years. Continued efforts should focus on optimizing the balance between patient access to specialty care and experience of the treating center.