title: Oesophageal cancer treatment in a tertiary referral hospital evaluated by indicators for quality of care.
abstract: BACKGROUND
  Studies on quality of care for oesophageal cancer patients usually include only traditional outcome parameters. The aim of the study was to address quality of care in a broader perspective.
  
  
  METHODS
  Between 2003 and 2008, 821 oesophageal cancer patients were referred to our institute. Indicators to measure quality of care (i.e., process and outcome measures) were defined and comparisons between two time periods were made.
  
  
  RESULTS
  335 patients came for a second opinion only, 382 patients received palliative treatment and 104 (13%) patients underwent potentially curative treatment. The median time between the first hospital visit and start of treatment decreased from 24 days in period I to 18 days in period II (P = 0.03). Of patients who underwent potentially curative treatment, 81% in period I and 86% in period II were discussed during a weekly multidisciplinary meeting (P = 0.54). Compliance with the national guideline was comparable in both periods (84% vs. 80%, P = 0.27). There were non-significant improvements in completion of chemoradiation (85% vs. 91%), postoperative complication rates (57% vs. 33%) and 3-year survival (40% vs. 46%).
  
  
  CONCLUSIONS
  By evaluating different dimensions of health care quality, we have identified which steps in the multidisciplinary care path need more attention in order to raise the whole level of care. Efforts for improvement should focus primarily on process measures rather than on outcome measures for which high-quality standards are already met.
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. ewoutcs@hotmail.com
authors.forename: E F W
authors.initials: EF
authors.lastname: Courrech Staal
authors.forename: K M
authors.initials: KM
authors.lastname: Bloemendal
authors.forename: M C
authors.initials: MC
authors.lastname: Bloemer
authors.forename: B M P
authors.initials: BM
authors.lastname: Aleman
authors.forename: A
authors.initials: A
authors.lastname: Cats
authors.forename: J W
authors.initials: JW
authors.lastname: van Sandick
mesh_terms: D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009426:Netherlands; D010166:Palliative Care / Q000379:methods; D011379:Prognosis; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome