title: Focusing on desired outcomes of care after colon cancer resections; hospital variations in 'textbook outcome'.
abstract: OBJECTIVE
  We propose a summarizing measure for outcome indicators, representing the proportion of patients for whom all desired short-term outcomes of care (a 'textbook outcome') is realized. The aim of this study was to investigate hospital variation in the proportion of patients with a 'textbook outcome' after colon cancer resections in the Netherlands.
  
  
  METHODS
  Patients who underwent a colon cancer resection in 2010 in the Netherlands were included in the Dutch Surgical Colorectal Audit. A textbook outcome was defined as hospital survival, radical resection, no reintervention, no ostomy, no adverse outcome and a hospital stay < 14 days. We calculated the number of hospitals with a significantly higher (positive outlier) or lower (negative outlier) Observed/Expected (O/E) textbook outcome than average. As quality measures may be more discriminative in a low-risk population, analyses were repeated for low-risk patients only.
  
  
  RESULTS
  A total of 5582 patients, treated in 82 hospitals were included. Average textbook outcome was 49% (range 26-71%). Eight hospitals were identified as negative outliers. In these hospitals a 'textbook outcome' was realized in 35% vs. 52% in average hospitals (p < 0.01). In a sub-analysis for low-risk patients, only one additional negative outlier was identified.
  
  
  CONCLUSIONS
  The textbook outcome, representing the proportion of patients with a perfect hospitalization, gives a simple comprehensive summary of hospital performance, while preventing indicator driven practice. Therewith the 'textbook outcome' is meaningful for patients, providers, insurance companies and healthcare inspectorate.
authors.affiliation: Leiden University Medical Centre, Dept of Surgery K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. N.e.kolfschoten@lumc.nl
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.forename: J
authors.initials: J
authors.lastname: Kievit
authors.forename: G A
authors.initials: GA
authors.lastname: Gooiker
authors.forename: N J
authors.initials: NJ
authors.lastname: van Leersum
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: E H
authors.initials: EH
authors.lastname: Eddes
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: P J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D016896:Treatment Outcome