Focusing on desired outcomes of care after colon cancer resections; Hospital variations in 'textbook outcome'

Journal article (2013)

Authors

N. E. Kolfschoten Leiden University Medical Center
J. Kievit Leiden University Medical Center
G. A. Gooiker Leiden University Medical Center
N.K. van Leersum Leiden University Medical Center
H.J. Snijders Leiden University Medical Center
E. H. Eddes Deventer Hospitals
R.A.E.M. Tollenaar Leiden University Medical Center
M. W.J.M. Wouters Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital
P.J. Marang-van de Mheen Leiden University Medical Center
Research Group
Safety and Security Science (TPM) (TU Delft)
Quality assurance Surgery Comparative assessment Colorectal neoplasma Outcomes of care
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Published Date

2013

Language

English

Reuse Rights

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Faculty

Technology, Policy and Management

Department

Values Technology and Innovation

Research Group

Safety and Security Science

Abstract

Aims: We propose a summarizing measure for outcome indicators, representing the proportion of patients for whom all desired short-term outcomes of care (a 'textbook outcome') is realized. The aim of this study was to investigate hospital variation in the proportion of patients with a 'textbook outcome' after colon cancer resections in the Netherlands. Methods: Patients who underwent a colon cancer resection in 2010 in the Netherlands were included in the Dutch Surgical Colorectal Audit. A textbook outcome was defined as hospital survival, radical resection, no reintervention, no ostomy, no adverse outcome and a hospital stay < 14 days. We calculated the number of hospitals with a significantly higher (positive outlier) or lower (negative outlier) Observed/Expected (O/E) textbook outcome than average. As quality measures may be more discriminative in a low-risk population, analyses were repeated for low-risk patients only. Results: A total of 5582 patients, treated in 82 hospitals were included. Average textbook outcome was 49% (range 26-71%). Eight hospitals were identified as negative outliers. In these hospitals a 'textbook outcome' was realized in 35% vs. 52% in average hospitals (p < 0.01). In a sub-Analysis for low-risk patients, only one additional negative outlier was identified. Conclusions: The textbook outcome, representing the proportion of patients with a perfect hospitalization, gives a simple comprehensive summary of hospital performance, while preventing indicator driven practice. Therewith the 'textbook outcome' is meaningful for patients, providers, insurance companies and healthcare inspectorate.