Date of Award


Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Saral Mehra


Background and Purpose: Oral squamous cell carcinoma (OSCC) often requires multidisciplinary care at different treatment settings. The facility at which patients receive treatment has been shown to impact outcomes in head and neck cancers and can be an important determinant of quality of care, which can be assessed with process-related quality metrics. In this study, we examined the impact of treatment facility settings across a single health system and region on process-related quality metrics for OSCC.

Methods: Patients with OSCC diagnosed between 2012-2018 were identified retrospectively from tumor registries of the six hospitals (one academic and five community hospitals) that comprise the Yale-New Haven Health System. Patients were categorized into three groups of care: 1) solely at the academic center (‘academic only’ group), 2) solely at a community facility (‘community only’ group), 3) combined care at academic and community facilities (‘combined’ group). Primary outcome measures were the following four process-related quality metrics: positive surgical margins, lymph node yield (LNY), adjuvant treatment initiation within six weeks, and NCCN (National Comprehensive Care Network) guideline adherence. Process-related quality metrics were compared across the three groups of care using multivariate regressions and contextualized within national benchmarks for these metrics. Secondary outcomes were 2-year and 5-year overall survival.

Results: 499 patients met inclusion criteria with 307 (61.5%) patients in the academic only group, 101 (20.2%) in the community only group, and 91 (18.2%) in the combined group. On multivariate analyses, surgery at the community hospitals was associated with significantly increased likelihood of positive surgical margins (OR: 22.27, 95% CI: 6.73-86.62, p

Conclusions: To our knowledge, this is the first study to assess process-related quality metrics for OSCC care across a single health system and region in the early phases of integration. Although we found differences in quality metrics across the groups of care, the quality of care provided across the health system and region was better than or comparable to national benchmarks. These baseline differences in quality metrics across treatment facilities present an opportunity for health systems to disseminate best practices and improve patient outcomes. Leveraging health systems to elevate the quality of care delivered at all hospitals can bring quality cancer care closer to home for patients.


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