Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer
Are scores consistent with short-term outcome?
N. E. Kolfschoten (Leiden University Medical Center)
G. A. Gooiker (Leiden University Medical Center)
E. Bastiaannet (Leiden University Medical Center)
N. J. Van Leersum (Leiden University Medical Center)
C. J.H. Van De Velde (Leiden University Medical Center)
E. H. Eddes (Deventer Hospitals)
P. J. Marang-van De Mheen (Leiden University Medical Center)
J. Kievit (Leiden University Medical Center)
E. Van Der Harst (Maasstad Ziekenhuis)
T. Wiggers (University Medical Center Groningen)
M. W.J.M. Wouters (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis)
R.A.E.M. Tollenaar (Leiden University Medical Center)
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Abstract
Objective: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. Design: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hospitals. Setting: The Dutch Surgical Colorectal Audit database, the Netherlands. Participants: 4732 elective patients with colon carcinoma and 2239 with rectum carcinoma treated in 85 hospitals were included in the analyses. Main outcome measures: All available process indicators were aggregated into five different composite measures. The association of the different composite measures with risk-adjusted postoperative mortality and morbidity was analysed at the patient and hospital level. Results: At the patient level, only one of the composite measures was negatively associated with morbidity for rectum carcinoma. At the hospital level, a strong negative association was found between composite measures and hospital mortality and morbidity rates for rectum carcinoma (p<0.05), and hospital morbidity rates for colon carcinoma. Conclusions: For individual patients, a high score on the composite measures based on process indicators is not associated with better short-term outcome. However, at the hospital level, a good score on the composite measures based on process indicators was consistent with more favourable risk-adjusted short-term outcome rates.