Evidence-based quality standards improve prognosis in colon cancer care

被引：39

作者：

Trautmann, Freya ^{[1
,2
,3
,4
]}

Reissfelder, Christoph ^{[2
,5
]}

Pecqueux, Mathieu ^{[2
,5
]}

Weitz, Juergen ^{[2
,5
]}

Schmitt, Jochen ^{[1
,2
,3
,4
]}

机构：

[1] Tech Univ Dresden, Univ Hosp, Natl Ctr Tumor Dis NCT, Partner Site Dresden,Fetscherstr 74, D-01307 Dresden, Germany

[2] Tech Univ Dresden, Med Fac Carl Gustav Carus, Fetscherstr 74, D-01307 Dresden, Germany

[3] German Canc Res Ctr, Fetscherstr 74, D-01307 Dresden, Germany

[4] Tech Univ Dresden, Ctr Evidence Based Healthcare ZEGV, Univ Hosp, Fetscherstr 74, D-01307 Dresden, Germany

[5] Tech Univ Dresden, Dept Visceral Thorac & Vasc Surg, Univ Hosp, Fetscherstr 74, D-01307 Dresden, Germany

来源：

EJSO | 2018年 / 44卷 / 09期

关键词：

Colon cancer; Certification; Surgery; Quality of care; Routine data; Health services research; COLORECTAL-CANCER; HEALTH-CARE; HOSPITAL VOLUME; CENTERS; SURVIVAL; INSTITUTE; OUTCOMES; SURGEON;

D O I：

10.1016/j.ejso.2018.05.013

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Colon cancer requires interdisciplinary care with quality of initial surgical treatment being a major prognostic factor. Implementation of quality standards based on structural and procedural indicators in routine care via certification (Germany) or accreditation (USA) is an established quality assurance method. However, evidence on effects is scarce. We undertook a population-based cohort study to investigate the effectiveness of colon cancer care in certified vs non-certified hospitals. Materials and methods: We utilized data of a large statutory health insurance including in - and outpatient data from 2005 to 2015 of >2 million individuals from Saxony, Germany. Case definitions were based on diagnosis, medical procedures and prescriptions. Patients treated in certified hospitals (CH) were compared to patients treated in non-certified hospitals (NCH) using logistic and Cox regression models adjusting for relevant confounders concerning overall survival (OS), disease-specific survival (DSS), 30-day mortality, recurrence, complications and second resections within 6 months after first resection (SR). Results: Overall, 6186 patients with incident colon cancer undergoing surgery were identified (mean age 74.1 +/- 11.0 years, 51.1% male) with 2120 (34.3%) patients treated in a CH. Confounder-adjusted regression models indicated positive effects in CH on OS (HR = 0.90, 95%CI: 0.83-0.97), DSS (HR = 0.71, 95%CI: 0.57-0.88), 30-day mortality (OR = 0.69, 95%CI: 0.55-0.87) and SR (OR = 0.51, 95%CI: 0.30-0.87). These results remained stable after adjustment for hospital volume. 30-day mortality in 2014 was 41% lower in CH (7.4%) compared to NCH (12.6%). Conclusions: This study indicates that the implementation and assurance of evidence-based quality standards has substantial positive effects on various patient-relevant outcomes in colon cancer care. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

引用

页码：1324 / 1330

页数：7

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