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Kwaliteit van rectale kankerzorg - fase 3 : statistische methoden om centra te benchmarken met een set van kwaliteitsindicatoren [printed text] / Els Goetghebeur, Author ; Ronan Van Rossem, Author ; Katrien Baert, Author ; Kurt Vanhoutte, Author ; Tom Boterberg, Author ; Pieter Demetter, Author ; Mark De Ridder, Author ; David Harrington, Author ; Marc Peeters, Author ; Guy Storme, Author ; Johanna Verhulst, Author ; Joan Vlayen , Author ; France Vrijens , Author ; Stijn Vansteedlandt, Author ; Wim Ceelen, Author . - Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre, 2011 . - XIII, 114 p. : ill. ; A4. - (KCE Reports A. Good Clinical Practice (GCP); 161A) .
ISSN : D/2011/10.273/38 : € 0,00
Studie nr 2010-04
Languages : English (eng) Dutch (nla)

Descriptors:	Indexation 2010-04 ; Benchmarking ; Quality Indicators, Health Care ; Quality of Health Care ; R161 ; Rectal Neoplasms ; Regression analysis Classification WI 610 Anus. Rectum -- Neoplams
Abstract:	Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) zocht samen met UGent de beste manier om de zorgkwaliteit voor rectumkanker in kaart te brengen. De artsen van de PROCARE groep stelden de anonieme gegevens ter beschikking van 3300 patiënten uit 79 Belgische ziekenhuizen. Bij de beoordeling werd o.m. rekening gehouden met het feit dat niet alle kankers in een even ver gevorderd stadium zijn, want alleen al hierdoor kunnen de resultaten verschillen van ziekenhuis tot ziekenhuis. Daarnaast werd ook getracht de grote hoeveelheid aan kwaliteitsinformatie te bundelen in enkele samenvattende indicatoren. De inspanningen die de voorbije jaren werden geleverd om de chirurgie te standaardiseren blijken succesvol te zijn. Op het gebied van diagnose en weefselonderzoek bestaan er wel nog veel verschillen tussen ziekenhuizen. De ontwikkelde methode van kwaliteitsevaluatie van rectumkanker is ook bruikbaar voor andere soorten kankers.
Contents note:	LIST OF TABLES 3 -- LIST OF FIGURES 5 -- LIST OF ABBREVIATIONS 6 -- ABBREVIATED LIST OF AVAILABLE QCIS 7 -- 1 INTRODUCTION AND RESEARCH QUESTIONS 9 -- 1.1 BACKGROUND 9 -- 1.2 THE CURRENT PROJECT 9 -- 2 CONCEPTUAL FRAMEWORK AND METHODOLOGICAL APPROACH FOR -- THE ESTIMATION AND BENCH MARKING OF CENTER EFFECTS ON -- QUALITY INDEXES 11 -- 2.1 PATIENT MIX ADJUSTMENT FOR QUALITY OF CARE INDICATORS. 11 -- 2.1.1 The causal inference framework for center effects 11 -- 2.1.2 A motivated choice among different modeling approaches 12 -- 2.1.3 Limitations due to restricted variable access 13 -- 2.1.4 On the Instrumental Variables method 14 -- 2.1.5 Outcome regression methods and propensity score methods 15 -- 2.1.6 Scope of analysis 18 -- 2.2 LITERATURE SEARCH FOR PROGNOSTIC FACTORS OF RECTAL CANCER 20 -- 2.2.1 Methodological approach 20 -- 2.2.2 Results 20 -- 2.2.3 Discussion 21 -- 2.3 DIMENSIONS OF CARE AND THEIR AGGREGATION 22 -- 2.3.1 Goal 22 -- 2.3.2 Key approach 23 -- 2.3.3 Criteria for indexes 24 -- 2.3.4 Other issues in the construction of quality indicators and quality indexes 31 -- 2.4 REVIEW OF STATISTICAL METHODS FOR PROVIDER PROFILING 33 -- 2.4.1 Goals 33 -- 2.4.2 Methods for provider profiling in the literature 33 -- 2.4.3 Visualizing variation between centers 35 -- 2.4.4 Graphical presentation of center results 37 -- 2.5 PROPOSED APPROACH FOR PROCARE 40 -- 2.5.1 Choice of index 40 -- 2.5.2 Adjusting for patient specific factors 40 -- 2.5.3 Bench marking 40 -- 2.5.4 Visualization 40 -- 3 APPLICATION AND RESULTS ON THE PROCARE DATABASE 42 -- 3.1 INTRODUCTION 42 -- 3.2 METHODS 44 -- 3.2.1 Descriptive statistics 44 -- 3.2.2 Identification of relevant prognostic factors 45 -- 3.2.3 Estimation of unadjusted and case mix adjusted center effects 46 -- 3.3 DESCRIPTION OF THE STUDY COHORT 47 -- 3.3.1 Centers 47 -- 3.3.2 Prognostic factors 49 -- 3.3.3 Associations between prognostic factors 55 -- 3.3.4 Joint missingness patterns of prognostic factors 58 -- 3.3.5 Follow-up information 58 -- 3.4 DESCRIPTION AND ANALYSIS OF INDIVIDUAL QUALITY OF CARE INDICATORS 60 -- 3.4.1 The worked out case of Overall Survival QCI 1111 60 -- 3.4.2 Tabulated results for the QCIs 69 -- 3.5 SUMMARY POINTS 76 -- 4 AGGREGATED QUALITY INDEXES 78 -- 4.1 INTRODUCTION 78 -- 4.2 METHODS 78 -- 4.2.1 Evaluation of quality and reliability of the QCIs 78 -- 4.2.2 Number of dimensions needed 78 -- 4.2.3 Clinical importance and discriminating ability of selected QCIs per dimension 78 -- 4.2.4 Construction of the Quality Index 78 -- 4.2.5 Risk adjustment 79 -- 4.3 AN AGGREGATED OUTCOME QUALITY INDEX 79 -- 4.3.1 Quality and reliability of the QCIs 79 -- 4.3.2 Concurrent validity of the selected QCIs 79 -- 4.3.3 Clinical importance and discriminating ability of the selected QCIs per dimension 79 -- 4.3.4 Constructing the quality index (QI) 80 -- 4.3.5 Adjusting the outcome QI for patient characteristics 82 -- 4.4 AN AGGREGATED PROCESS QUALITY INDEX 85 -- 4.4.1 Quality and reliability of the QCIs 85 -- 4.4.2 Concurrent validity of selected QCIs 85 -- 4.4.3 Clinical importance and discriminating ability of selected QCIs per dimension 85 -- 4.4.4 Construction of the quality index (QI) 85 -- 4.5 AGGREGATED QUALITY INDEXES PER DOMAIN 90 -- 4.5.1 Overview of results 90 -- 4.5.2 Overview of variation per domain 98 -- 4.6 AN OVERALL COMPOSITE QUALITY INDEX 98 -- 5 MODEL BUILDING TO EXPLAIN EXCESS PROBABILITIES 101 -- 5.1 INTRODUCTION 101 -- 5.2 METHODOLOGY: FORWARD STEPWISE REGRESSION 101 -- 5.3 EXPLANATORY DESCRIPTIVES FOR EXTREME CENTER PERFORMANCE 102 -- 5.4 FORWARD STEPWISE REGRESSION 106 -- 6 DISCUSSION 108 -- 7 BIBLIOGRAPHY 112
Link for e-copy:	https://doi.org/10.57598/R161A
Format of e-copy:	PDF (1,6 MB)
Record link:	https://kce.docressources.info/index.php?lvl=notice_display&id=2633