Variation in Integrated Head and Neck Cancer Care: Impact of Patient and Hospital Characteristics

Abstract

Background: Monitoring and effectively improving oncologic integrated care requires dashboard information based on quality registrations. The dashboard includes evidence-based quality indicators (QIs) that measure quality of care. This study aimed to assess the quality of current integrated head and neck cancer care with QIs, the variation between Dutch hospitals, and the influence of patient and hospital characteristics. Methods: Previously, 39 QIs were developed with input from medical specialists, allied health professionals, and patients' perspectives. QI scores were calculated with data from 1,667 curatively treated patients in 8 hospitals. QIs with a sample size of >400 patients were included to calculate reliable QI scores. We used multilevel analysis to explain the variation. Results: Current care varied from 29% for the QI about a case manager being present to discuss the treatment plan to 100% for the QI about the availability of a treatment plan. Variation between hospitals was small for the QI about patients discussed in multidisciplinary team meetings (adherence: 95%, range 88%-98%), but large for the QI about malnutrition screening (adherence: 50%, range 2%-100%). Higher QI scores were associated with lower performance status, advanced tumor stage, and tumor in the oral cavity or oropharynx at the patient level, and with more curatively treated patients (volume) at hospital level. Conclusions: Although the quality registration was only recently launched, it already visualizes hospital variation in current care. Four determinants were found to be influential: tumor stage, performance status, tumor site, and volume. More data are needed to assure stable results for use in quality improvement.

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

“…Previous analyses have shown how demographic and socioeconomic markers such as insurance status, ethnicity, and hospital travel distance influence treatment access for head and neck cancer, and they have highlighted disparities in treatment access across the United States . Large database studies have found that patients with head and neck cancer with nonprivate insurance tend to receive care at hospitals with poorer outcomes in comparison with their privately insured counterparts .…”

“…We observed that more upfront surgical therapy was seen in younger patients, female patients, patients with increased comorbidity scores, patients living in the Pacific regions of the United States, those traveling >25 miles for treatment, and patients treated at top‐volume hospitals, regardless of whether they were academic or community institutions. Although an analysis of survival or functional outcomes was not part of our study, wide variability in treatment access often mirrors variation in health quality outcomes . Advanced treatment modalities such as TOS approaches and intensity‐modulated radiation therapy and access to other medical specialists (eg, speech and language pathologists, audiologists, dentists, and nutritionists) may be limited at low‐volume centers yet play critical roles in function and survivorship.…”

“…9 Previous analyses have shown how demographic and socioeconomic markers such as insurance status, ethnicity, and hospital travel distance influence treatment access for head and neck cancer, and they have highlighted disparities in treatment access across the United States. [23][24][25][26][27] Large database studies have found that patients with head and neck cancer with nonprivate insurance tend to receive care at hospitals with poorer outcomes in comparison with their privately insured counterparts. 24 We observed that more upfront surgical therapy was seen in younger patients, female patients, patients with increased comorbidity scores, patients living in the Pacific regions of the United States, those traveling >25 miles for treatment, and patients treated at top-volume hospitals, regardless of whether they were academic or community institutions.…”

“…Although an analysis of survival or functional outcomes was not part of our study, wide variability in treatment access often mirrors variation in health quality outcomes. 26,[28][29][30] Advanced treatment modalities such as TOS approaches and intensity-modulated radiation therapy and access to other medical specialists (eg, speech and language pathologists, audiologists, dentists, and nutritionists) may be limited at low-volume centers yet play critical roles in function and survivorship. In our study, each treatment quartile included approximately 3340 patients, who were divided between 1033 hospitals; thus, the top quartile (n = 29; 3% of hospitals; ~23.0 patients per year) treated more than 25 times more patients per year than bottom-quartile centers (n = 741; 72% of hospitals; ~0.9 patients per year).…”

Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study

“…The usefulness of the quality indicators was based on three criteria [14]: feasibility [15], discriminability [16,17], and statistical uncertainty [15,18,19]. As no previous studies report thresholds on these criteria, we set a priori thresholds based on consensus.…”