National Comparison of Hospital Performances in Lung Cancer Surgery: The Role of Case Mix Adjustment

Beck, Naomi; Hoeijmakers, Fieke; Willik, Esmee M van der; Heineman, David J.; Braun, Jerry; Tollenaar, Rob A.E.M.; Schreurs, Wilhelmina H.; Wouters, Michel W. J. M.

doi:10.1016/j.athoracsur.2018.02.074

Cited by 21 publications

(26 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Each consists of one or two tertiary referral centers which perform liver surgery and several regionals hospitals of which a few perform liver surgery [26]. This structure of oncological care can be a reason for the variation in case-mix between hospitals and this variation in casemix is in concordance with earlier studies on colorectal cancer and thoracic surgery in the Netherlands [15,27].…”

Section: Discussionsupporting

confidence: 73%

Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Elfrink

Zwet²,

Swijnenburg

et al. 2021

European Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80

show abstract

Section: Discussionsupporting

confidence: 73%

Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Elfrink

Zwet²,

Swijnenburg

et al. 2021

European Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…They found a wide variety of mortality and complication rates amongst different facilities but noted that there was also a wide variety in case complexity amongst hospitals. Thus, they suggest that, in order to develop care benchmarks or measure hospitals' ability to meet set standards, one must perform case mix adjustments [ 37 ]. Physicians who take on more complex cases are expected to have more complications, which should be taken into consideration when evaluating and comparing individual outcomes.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Feedback on Surgeon Performance: A Narrative Review

Rankin

Brand

Wiznia

2020

Advances in Orthopedics

View full text Add to dashboard Cite

Surgeons play a critical role in the healthcare community and provide a service that can tremendously impact patients’ livelihood. However, there are relatively few means for monitoring surgeons’ performance quality and seeking improvement. Surgeon-level data provide an important metric for quality improvement and future training. A narrative review was conducted to analyze the utility of providing surgeons direct feedback on their individual performance. The articles selected identified means of collecting surgeon-specific data, suggested ways to report this information, identified pertinent gaps in the field, and concluded the results of giving feedback to surgeons. There is a relative sparsity of data pertaining to the effect of providing surgeons with information regarding their individual performance. However, the literature available does suggest that providing surgeons with individualized feedback can help make meaningful improvements in the quality of practice and can be done in a way that is safe for the surgeons’ reputation.

show abstract

“…We used the following patient-level or fixed-effects variables in the model: age, gender, ECOG PS, and tumor stage. These case-mix variables were similar to what was previously used [29,30], but we lack other lung cancer-specific data, such as data on the presence of symptoms such as chest pain and hemoptysis. Additionally, we included the referral status of a patient.…”

Section: Regression Modelmentioning

confidence: 99%

Variation in the time to treatment for stage III and IV non-small cell lung cancer patients for hospitals in the Netherlands

et al. 2019

View full text Add to dashboard Cite

Increased emphasis on molecular diagnostics can lead to increased variation in time to treatment (TTT) for patients with stage III and IV non-small cell lung cancer. This article presents the variation in TTT for advanced NSCLC patients observed in Dutch hospitals before the widespread use of immunotherapy. The aim of this article was to explore the variation in TTT between patients, as well as between hospitals. Material and methods: Based on the Netherlands Cancer Registry, we used patient-level data (n = 4096) from all 78 hospitals that diagnosed stage III or IV NSCLC in the Netherlands in 2016. To investigate how patient characteristics and hospital-level effects are associated with TTT (from diagnosis until start treatment), we interpreted regression model results for five common patient profiles to analyze the influence of age, gender, tumor stage, performance status, histology, and referral status as well as hospital-level characteristics on the TTT. Results and conclusions: TTT varies substantially between and within hospitals. The median TTT was 28 days with an inter-quartile range of 22 days. The hospital-level median TTT ranges from 17 to 68 days. TTT correlates significantly with tumor stage, performance status, and histology. The hospital-level effect, unrelated to hospital volume and type, affected TTT by several weeks at most. For most patients, TTT is within range as recommended in current guidelines. Variation in TTT seems higher for patients receiving either radiotherapy or targeted therapy, or for patients referred to another hospital and we hypothesize this is related to the complexity of the diagnostic pathway. With further advances in molecular diagnostics and precision oncology we expect variation in TTT to increase and this needs to be considered in designing optimal cancer care delivery.

show abstract

National Comparison of Hospital Performances in Lung Cancer Surgery: The Role of Case Mix Adjustment

Abstract: The between-hospital variation in case mix of patients undergoing surgical treatment for non-small cell lung cancer emphasizes the importance of proper adjustment when comparing hospitals on outcome indicators.

Cited by 21 publications

References 13 publications

Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

The Effect of Feedback on Surgeon Performance: A Narrative Review

Variation in the time to treatment for stage III and IV non-small cell lung cancer patients for hospitals in the Netherlands

Contact Info

Product

Resources

About