title: Quality of integrated care for patients with nonsmall cell lung cancer: variations and determinants of care.
abstract: BACKGROUND
  In the current study, the authors focused on determinants influencing the quality of care and variations in the actual quality of integrated care for patients with nonsmall cell lung cancer (NSCLC) to estimate whether there is room for improvement.
  
  
  METHODS
  The authors tested the quality of integrated care for 276 NSCLC patients with 14 quality indicators of professional (4 indicators), organizational (3 indicators), and patient-oriented quality (7 indicators). Patient characteristics and actual care data were derived from medical record data, patient-oriented care was derived from patient questionnaires, and professional and hospital characteristics were derived from questionnaires for professionals. The performance measure was the proportion of patients to whom the indicator applied who had positive scores on the indicator. Multilevel logistic regression analysis determined the influence of patient, professional, and hospital characteristics on care.
  
  
  RESULTS
  With regard to professional quality, the proportions of patients who underwent fluorodeoxyglucose-positron emission tomography or cervical mediastinoscopy according to the guideline criteria were 88% and 84%, respectively. Only 50% of the biopsies were adequately obtained during mediastinoscopy, and in 3% of the patients with clinical stage III disease (based on the TNM classification) there was a search for brain metastases before the initiation of combination therapy. With regard to organizational quality, the diagnostic route of 79% of the patients was completed within 21 days; 51% of patients began therapy within 35 days and 57% were discussed during multidisciplinary consultation. All but 1 patient-oriented quality indicator scored </=58%. Hospitals varied by >/=20% with regard to 11 of the 14 indicators. The patient-related determinants "stage of disease," "age," and "comorbidity" were found to influence the indicator scores the most.
  
  
  CONCLUSIONS
  The quality of integrated care (especially patient-oriented care) for NSCLC patients needs improvement. Patient characteristics appear to influence performance more than professional or hospital characteristics.
authors.affiliation: Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Ouwens@kwazo.umcn.nl
authors.forename: Mariëlle M M T J
authors.initials: MM
authors.lastname: Ouwens
authors.forename: Rosella R P M G
authors.initials: RR
authors.lastname: Hermens
authors.forename: René A R
authors.initials: RA
authors.lastname: Termeer
authors.forename: Saskia Y
authors.initials: SY
authors.lastname: Vonk-Okhuijsen
authors.forename: Vivianne C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.forename: Ad F T M
authors.initials: AF
authors.lastname: Verhagen
authors.forename: Marlies M E J L
authors.initials: MM
authors.lastname: Hulscher
authors.forename: Henri A M
authors.initials: HA
authors.lastname: Marres
authors.forename: Hub C H
authors.initials: HC
authors.lastname: Wollersheim
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000628:therapy*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care