Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan

<p>Abstract</p> <p>Background</p> <p>Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance.</p> <p>Methods</p> <p>The development of core measures for colorectal cancer has undergone three stages including a modified Delphi method. The study sample originated from 2004 data in the Taiwan Cancer Database, a national cancer data registry. Eighteen hospitals and 5585 newly diagnosed colorectal cancer patients were enrolled in this study. We used indicator-based and case-based approaches to examine adherences simultaneously.</p> <p>Results</p> <p>The final core measure set included seventeen indicators (1 pre-treatment, 11 treatment-related and 5 monitoring-related). There were data available for ten indicators. Indicator-based adherence possesses more meaningful application than case-based adherence for hospital comparisons. Mean adherence was 85.8% (79.8% to 91%) for indicator-based and 82.8% (77.6% to 88.9%) for case-based approaches. Hospitals performed well (>90%) for five out of eleven indicators. Still, the performance across hospitals varied for many indicators. The best and poorest system performance was reflected in indicators T5-negative surgical margin (99.3%, 97.2% - 100.0%) and T7-lymph nodes harvest more than twelve(62.7%, 27.6% - 92.2%), both of which related to surgical specimens.</p> <p>Conclusions</p> <p>In this nationwide study, quality of colorectal cancer care still shows room for improvement. These preliminary results indicate that core measures for cancer can be developed systematically and applied for internal quality improvement.</p

Effects of tumor staging and treatment modality on functional outcome and quality of life after treatment for laryngeal cancer

An earlier stage of primary disease at diagnosis is associated with better survival from laryngeal cancer. It remains unproven whether earlier stage is also associated with improved end-organ function and quality of life after treatment. Questionnaire packs were posted to 250 patients with laryngeal cancer treated between January 2006 and December 2008 within the West of Scotland. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). One hundred forty-seven eligible patients provided data for analysis (59% of original cohort). Patients with an earlier stage of primary disease reported significantly better VoiSS, MDADI, and UW-QOL scores (p < .05). No differences were found between scores of patients with T1 laryngeal disease treated with endoscopic laser resection (ELR) and radiotherapy. An earlier stage at diagnosis is associated with significantly better end-organ function and quality of life after treatment for laryngeal cancer. © 2013 Wiley Periodicals, Inc. Head Neck, 2013