Assessing Quality of Colorectal Cancer Care at Commission on Cancer Accredited Hospitals

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.

Hospitals were evaluated using two 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 Centers for Medicare & Medicaid Services. Hospitals were compared by performance tier and CoC accreditation status.

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 (HR 0.63, 95%CI 0.6-0.66), whereas low-tier hospitals had higher hazard (HR 1.51, 95%CI 1.44-1.58). 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 0.81-0.90). 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 0.76-0.87), medium-tier HR 0.91 (95%CI 0.87-0.95); Criteria Method-high-performing HR 0.83 (95%CI 0.77-0.88), average-performing HR 0.92 (95%CI 0.88-0.96).

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 systems-level marker of quality.