title: Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome?
abstract: OBJECTIVE
  To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care.
  
  
  METHODS
  Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hospitals.
  
  
  METHODS
  The Dutch Surgical Colorectal Audit database, the Netherlands.
  
  
  METHODS
  4732 elective patients with colon carcinoma and 2239 with rectum carcinoma treated in 85 hospitals were included in the analyses.
  
  
  METHODS
  All available process indicators were aggregated into five different composite measures. The association of the different composite measures with risk-adjusted postoperative mortality and morbidity was analysed at the patient and hospital level.
  
  
  RESULTS
  At the patient level, only one of the composite measures was negatively associated with morbidity for rectum carcinoma. At the hospital level, a strong negative association was found between composite measures and hospital mortality and morbidity rates for rectum carcinoma (p<0.05), and hospital morbidity rates for colon carcinoma.
  
  
  CONCLUSIONS
  For individual patients, a high score on the composite measures based on process indicators is not associated with better short-term outcome. However, at the hospital level, a good score on the composite measures based on process indicators was consistent with more favourable risk-adjusted short-term outcome rates.
authors.affiliation: Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.forename: G A
authors.initials: GA
authors.lastname: Gooiker
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: N J
authors.initials: NJ
authors.lastname: van Leersum
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: E H
authors.initials: EH
authors.lastname: Eddes
authors.forename: P J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
authors.forename: J
authors.initials: J
authors.lastname: Kievit
authors.forename: E
authors.initials: E
authors.lastname: van der Harst
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
mesh_terms: D015179:Colorectal Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013514:Surgical Procedures, Operative / Q000592:standards*