Quality-of-care indicators for oesophageal cancer surgery: A review.
BACKGROUND
Quality-of-care indicators are measurable elements of practice performance that can assess the (change in) quality of the care provided. To date, the literature on quality-of-care indicators for oesophageal cancer surgery has not been reviewed.


METHODS
We performed a review of the literature on quality-of-care indicators for oesophageal cancer surgery. The indicators were classified by their nature of care provision (structural, process, or outcome).


RESULTS
One hundred thirty articles were included. For structural measures, most evidence was found for the inverse relationship between hospital or surgeon volume and post-operative mortality. Few articles described the required infrastructural and organisational elements for oesophageal cancer surgery. Regarding process measures, the most common indicators were determinants of patient selection for surgery. Other process indicators with considerable evidence were found (e.g., multidisciplinary team management), though the number of studies was small. For outcome indicators, the level of evidence for pathological outcome measures was strong. Data on post-operative complications as outcome indicators varied widely.


CONCLUSIONS
Since there is considerable variation in the evaluation of quality of care, the uniform use of well-defined quality-of-care indicators to measure and document practice performance holds the promise of improving outcome in patients who undergo oesophageal cancer surgery.
Courrech Staal
E F W
EF
Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van, Leeuwenhoek Hospital, Amsterdam, The Netherlands. e.courrech@nki.nl
Wouters
M W J M
MW
Boot
H
H
Tollenaar
R A E M
RA
van Sandick
J W
JW
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006801:Humans; D007902:Length of Stay; D037981:Neck Dissection; D009367:Neoplasm Staging; D009426:Netherlands; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D018579:Patient Selection; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors