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...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3928280?pdf=render |
| _version_ | 1818701140735295488 |
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| author | Nikki E Kolfschoten Perla J Marang-van de Mheen Michel W J M Wouters Eric-Hans Eddes Rob A E M Tollenaar Theo Stijnen Job Kievit Dutch Surgical Colorectal Audit Group |
| author_facet | Nikki E Kolfschoten Perla J Marang-van de Mheen Michel W J M Wouters Eric-Hans Eddes Rob A E M Tollenaar Theo Stijnen Job Kievit Dutch Surgical Colorectal Audit Group |
| author_sort | Nikki E Kolfschoten |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-17T15:16:07Z |
| format | Article |
| id | doaj.art-7c2611246d1f493ea97223962f8b1e7a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-17T15:16:07Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-7c2611246d1f493ea97223962f8b1e7a2022-12-21T21:43:32ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0192e8873710.1371/journal.pone.0088737A combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data.Nikki E KolfschotenPerla J Marang-van de MheenMichel W J M WoutersEric-Hans EddesRob A E M TollenaarTheo StijnenJob KievitDutch Surgical Colorectal Audit GroupOBJECTIVE: 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.http://europepmc.org/articles/PMC3928280?pdf=render |
| spellingShingle | Nikki E Kolfschoten Perla J Marang-van de Mheen Michel W J M Wouters Eric-Hans Eddes Rob A E M Tollenaar Theo Stijnen Job Kievit Dutch Surgical Colorectal Audit Group A combined measure of procedural volume and outcome to assess hospital quality of colorectal cancer surgery, a secondary analysis of clinical audit data. PLoS ONE |
| 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 |
| url | http://europepmc.org/articles/PMC3928280?pdf=render |
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