title: Disparities in quality of care for colon cancer between hospitals in the Netherlands.
abstract: BACKGROUND
  Aim of this study was to describe treatment patterns and outcome according to region, and according to hospital types and volumes among patients with colon cancer in the Netherlands.
  
  
  METHODS
  All patients with invasive colon carcinoma diagnosed in the period 2001-2006 were selected from the Netherlands Cancer Registry. Logistic regression analyses were performed to examine the influence of relevant factors on the odds of having adequate lymph node evaluation, receiving adjuvant chemotherapy and postoperative mortality. Relative survival analysis was used to estimate relative excess risk of dying according to hospital type and volume.
  
  
  RESULTS
  In total, 39 907 patients were selected. Patients diagnosed in a university hospital had a higher odds (OR 2.47; 95% CI 2.19-2.78) and patients diagnosed in a hospital with >100 colon carcinoma diagnoses annually had a lower odds (OR 0.70; 95% CI 0.64-0.77) of having >/=10 lymph nodes evaluated. The odds of receiving adjuvant chemotherapy was lower in patients diagnosed in teaching hospitals (OR 0.85; 95% CI 0.73-0.98) and university hospitals (OR 0.56; 95% CI 0.45-0.70) compared to patients diagnosed in non-teaching hospitals. Funnel plots showed large variation in these two outcome measures between individual hospitals. No differences in postoperative mortality were found between hospital types or volumes. Patients diagnosed in university hospitals and patients diagnosed in hospitals with >50 diagnoses of colon carcinoma per year had a better survival.
  
  
  CONCLUSIONS
  Variation in treatment and outcome of patients with colon cancer in the Netherlands was revealed, with differences between hospital types and volumes. However, variation seemed mainly based on the level of the individual hospital.
authors.affiliation: Department of Research, Comprehensive Cancer Centre North East, AH Groningen, The Netherlands. m.elferink@ikno.nl
authors.forename: M A G
authors.initials: MA
authors.lastname: Elferink
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: P
authors.initials: P
authors.lastname: Krijnen
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: M L E A
authors.initials: ML
authors.lastname: Jansen-Landheer
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: S
authors.initials: S
authors.lastname: Siesling
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011787:Quality of Health Care; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents