Relationship between compliance to quality indicators, volume, and outcomes in pancreatic cancer resection in a community hospital setting
DOI:
https://doi.org/10.46570/utjms.vol2-2015-102Keywords:
hospitals, community, quality indicators, health care, pancreatic neoplasmAbstract
Objective: To calculate and compare adherence to pancreatic cancer care quality indicators and related outcomes at three hospitals within our health system and determine their relatedness.
Design: Retrospective review of cancer registry data and patient charts from January 1, 2000 – December 31, 2010.
Setting: Three hospitals performing pancreatic resections within a single health system.
Patients: All patients undergoing resection for the treatment of pancreatic cancer.
Main Outcome Measures: Adherence to published quality indicators, patient survival, and surgical and institutional variables related to mortality.
Results: Complication, morbidity and mortality, and overall survival rates were similar between facilities and were comparable to previously reported values of similar volume facilities. Overall adherence to quality indicators was approximately 73%; compliance to indicators in the “outcome” and “efficiency” domains was highest, but adherence was not associated with clinical outcomes. Patient mortality was lowest at the highest volume hospital in our health system; however, surgeon volume was not predictive of outcomes.
Conclusion: Use of quality indicators is valuable in determining quality of care and identifying weaknesses, allowing for a targeted approach to improve quality of care and the associated processes. However, adherence to these quality indicators is not necessarily indicative of outcomes.
References
Langer B (2007) Role of volume outcome data in assuring quality in HPB surgery. HPB (Oxford) 9(5):330-334.
Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA (2006)Volume and pro- cess of care in high-risk cancer surgery. Cancer 106(11):2476-2481.
Riall TS, Nealon WH, Goodwin JS, Townsend CM, Jr., Freeman JL (2008) Outcomes following pancreatic resection: variability among high-volume providers. Surgery 144(2):133-140.
Glickman SW, et al. (2009) Alternative pay-for-performance scoring methods: impli- cations for quality improvement and patient outcomes. Med Care 47(10):1062-1068.
Halm EA, Lee C, Chassin MR (2001) Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 137(6):511-520.
Bilimoria KY, et al. (2008) Effect of hospital type and volume on lymph node evalu- ation for gastric and pancreatic cancer. Arch Surg 143(7):671-678; discussion 678.
Bilimoria KY, et al. (2008) Directing surgical quality improvement initiatives: com- parison of perioperative mortality and long-term survival for cancer surgery. J Clin Oncol 26(28):4626-4633.
Finlayson EV, Goodney PP, Birkmeyer JD (2003) Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg 138(7):721-725; discus- sion 726.
Birkmeyer JD (2000) High-risk surgery–follow the crowd. JAMA 283(9):1191-1193.
Raval MV, Bilimoria KY, Talamonti MS (2010) Quality improvement for pancreatic cancer care: is regionalization a feasible and effective mechanism? Surg Oncol Clin N Am 19(2):371-390.
Bilimoria KY, Bentrem DJ, Lillemoe KD, Talamonti MS, Ko CY (2009) Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst 101(12):848-859.
Gisvold SE, Fasting S (2011) How do we know that we are doing a good job - can we measure the quality of our work? Best Pract Res Clin Anaesthesiol 25(2):109-122.
Bilimoria KY, et al. (2001) National assessment of melanoma care using formally developed quality indicators. J Clin Oncol 27(32):5445-5451.
Maggard MA, McGory ML, Shekelle PG, Ko CY (2006) Quality indicators in bariatric surgery: improving quality of care. Surg Obes Relat Dis 2(4):423-429; discussion 429-430.
McGory ML, Shekelle PG, Ko CY (2006) Development of quality indicators for pa- tients undergoing colorectal cancer surgery. J Natl Cancer Inst 98(22):1623-1633.
R Core Team (2012) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.
Kazanjian KK, et al. (2008) Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss. Arch Surg 143(12):1166-1171.
Schwarz RE, Keny H (2001) Preoperative platelet count predicts survival after resec- tion of periampullary adenocarcinoma. Hepatogastroenterology 48(41):1493-1498.
Gooiker GA, et al. (2011) Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg 98(4):485-494.
Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA (2008) Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 249(4):635-640.
Sohn TA, et al. (2000) Resected adenocarcinoma of the pancreas-616 patients: re- sults, outcomes, and prognostic indicators. J Gastrointest Surg 4(6):567-579.
Greene F, et al., eds. AJCC Cancer Staging Handbook. 6th ed. Springer Publishing Company, 2002.
Edge B, Byrd D, Comptom C, Fritz A, Greene F, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed. Springer Publishing Company, 2010.
Wolff RA, Varadhachary GR, Evans DB (2008) Adjuvant therapy for adenocarci- noma of the pancreas: analysis of reported trials and recommendations for future progress. Ann Surg Oncol 15(10):2773-2786.
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