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A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data
OBJECTIVE: To identify, on the basis of past performance, those hospitals that demonstrate good outcomes in sufficient numbers to make it likely that they will provide adequate quality of care in the future, using a combined measure of volume and outcome (CM-V&O). To compare this CM-V&O with...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928280/ https://www.ncbi.nlm.nih.gov/pubmed/24558418 http://dx.doi.org/10.1371/journal.pone.0088737 |
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author | Kolfschoten, Nikki E. Marang-van de Mheen, Perla J. Wouters, Michel W. J. M. Eddes, Eric-Hans Tollenaar, Rob A. E. M. Stijnen, Theo Kievit, Job |
author_facet | Kolfschoten, Nikki E. Marang-van de Mheen, Perla J. Wouters, Michel W. J. M. Eddes, Eric-Hans Tollenaar, Rob A. E. M. Stijnen, Theo Kievit, Job |
author_sort | Kolfschoten, Nikki E. |
collection | PubMed |
description | OBJECTIVE: To identify, on the basis of past performance, those hospitals that demonstrate good outcomes in sufficient numbers to make it likely that they will provide adequate quality of care in the future, using a combined measure of volume and outcome (CM-V&O). To compare this CM-V&O with measures using outcome-only (O-O) or volume-only (V-O), and verify 2010-quality of care assessment on 2011 data. DESIGN: Secondary analysis of clinical audit data. SETTING: The Dutch Surgical Colorectal Audit database of 2010 and 2011, the Netherlands. PARTICIPANTS: 8911 patients (test population, treated in 2010) and 9212 patients (verification population, treated in 2011) who underwent a resection of primary colorectal cancer in 89 Dutch hospitals. MAIN OUTCOME MEASURES: Outcome was measured by Observed/Expected (O/E) postoperative mortality and morbidity. CM-V&O states 2 criteria; 1) outcome is not significantly worse than average, and 2) outcome is significantly better than substandard, with ‘substandard care’ being defined as an unacceptably high O/E threshold for mortality and/or morbidity (which we set at 2 and 1.5 respectively). RESULTS: Average mortality and morbidity in 2010 were 4.1 and 24.3% respectively. 84 (94%) hospitals performed ‘not worse than average’ for mortality, but only 21 (24%) of those were able to prove they were also ‘better than substandard’ (O/E<2). For morbidity, 42 hospitals (47%) met the CM-V&O. Morbidity in 2011 was significantly lower in these hospitals (19.8 vs. 22.8% p<0.01). No relationship was found between hospitals' 2010 performance on O-O en V-O, and the quality of their care in 2011. CONCLUSION: CM-V&O for morbidity can be used to identify hospitals that provide adequate quality and is associated with better outcomes in the subsequent year. |
format | Online Article Text |
id | pubmed-3928280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-39282802014-02-20 A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data Kolfschoten, Nikki E. Marang-van de Mheen, Perla J. Wouters, Michel W. J. M. Eddes, Eric-Hans Tollenaar, Rob A. E. M. Stijnen, Theo Kievit, Job PLoS One Research Article OBJECTIVE: To identify, on the basis of past performance, those hospitals that demonstrate good outcomes in sufficient numbers to make it likely that they will provide adequate quality of care in the future, using a combined measure of volume and outcome (CM-V&O). To compare this CM-V&O with measures using outcome-only (O-O) or volume-only (V-O), and verify 2010-quality of care assessment on 2011 data. DESIGN: Secondary analysis of clinical audit data. SETTING: The Dutch Surgical Colorectal Audit database of 2010 and 2011, the Netherlands. PARTICIPANTS: 8911 patients (test population, treated in 2010) and 9212 patients (verification population, treated in 2011) who underwent a resection of primary colorectal cancer in 89 Dutch hospitals. MAIN OUTCOME MEASURES: Outcome was measured by Observed/Expected (O/E) postoperative mortality and morbidity. CM-V&O states 2 criteria; 1) outcome is not significantly worse than average, and 2) outcome is significantly better than substandard, with ‘substandard care’ being defined as an unacceptably high O/E threshold for mortality and/or morbidity (which we set at 2 and 1.5 respectively). RESULTS: Average mortality and morbidity in 2010 were 4.1 and 24.3% respectively. 84 (94%) hospitals performed ‘not worse than average’ for mortality, but only 21 (24%) of those were able to prove they were also ‘better than substandard’ (O/E<2). For morbidity, 42 hospitals (47%) met the CM-V&O. Morbidity in 2011 was significantly lower in these hospitals (19.8 vs. 22.8% p<0.01). No relationship was found between hospitals' 2010 performance on O-O en V-O, and the quality of their care in 2011. CONCLUSION: CM-V&O for morbidity can be used to identify hospitals that provide adequate quality and is associated with better outcomes in the subsequent year. Public Library of Science 2014-02-18 /pmc/articles/PMC3928280/ /pubmed/24558418 http://dx.doi.org/10.1371/journal.pone.0088737 Text en © 2014 Kolfschoten et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Kolfschoten, Nikki E. Marang-van de Mheen, Perla J. Wouters, Michel W. J. M. Eddes, Eric-Hans Tollenaar, Rob A. E. M. Stijnen, Theo Kievit, Job A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title | A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title_full | A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title_fullStr | A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title_full_unstemmed | A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title_short | A Combined Measure of Procedural Volume and Outcome to Assess Hospital Quality of Colorectal Cancer Surgery, a Secondary Analysis of Clinical Audit Data |
title_sort | combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928280/ https://www.ncbi.nlm.nih.gov/pubmed/24558418 http://dx.doi.org/10.1371/journal.pone.0088737 |
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