Evidence-based quality standards improve prognosis in colon cancer care

Freya Trautmann; Christoph Reißfelder; Mathieu Pecqueux; Jürgen Weitz; Jochen Schmitt

doi:10.1016/j.ejso.2018.05.013

Evidence-based quality standards improve prognosis in colon cancer care

Eur J Surg Oncol. 2018 Sep;44(9):1324-1330. doi: 10.1016/j.ejso.2018.05.013. Epub 2018 May 17.

Authors

Freya Trautmann¹, Christoph Reißfelder², Mathieu Pecqueux², Jürgen Weitz², Jochen Schmitt³

Affiliations

¹ National Center for Tumor Diseases (NCT), (partner Site) Dresden, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany; Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
² Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
³ National Center for Tumor Diseases (NCT), (partner Site) Dresden, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany; Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany. Electronic address: jochen.schmitt@uniklinikum-dresden.de.

PMID: 29885983
DOI: 10.1016/j.ejso.2018.05.013

Abstract

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.

Keywords: Certification; Colon cancer; Health services research; Quality of care; Routine data; Surgery.

MeSH terms

Adult
Aged
Aged, 80 and over
Colonic Neoplasms / diagnosis
Colonic Neoplasms / epidemiology
Colonic Neoplasms / surgery*
Delivery of Health Care / standards*
Evidence-Based Medicine / methods*
Follow-Up Studies
Germany / epidemiology
Health Policy
Humans
Incidence
Middle Aged
Outcome Assessment, Health Care*
Prognosis
Retrospective Studies
Survival Rate / trends
Treatment Outcome
Young Adult