title: Measuring the impact of multidisciplinary care on quality for pancreatic surgery: transition to a focused, very high-volume program.
abstract: Outcomes are superior for pancreatic resection at high-volume centers. To assess the impact of focused high-volume multidisciplinary care, a quality index (QI) was used to review our experience. Data from 1996 to July 2012 were analyzed in three groups: 1) early (1996 to 2007); 2) transition (2008 to 2009); and 3) mature (2010 to July 2012). A total of 239 patients were included with a mean age of 63.4 years and the majority were white (65.7%). The number of patients with Charlson comorbidity index greater than 2 and age older than 80 years increased comparing Group 1 with latter groups. Volume increased over time: Group 1 (n = 93) 7.75/year, Group 2 (n = 51) 25.5/year, and Group 3 (n = 95) 39/year. Overall mortality was 5.9 per cent: Group 1, 4.3 per cent; Group 2, 11.5 per cent; and Group 3, 3.9 per cent (P = 0.0454). The QI score incorporates documentation, chemotherapy, resection for Stage I/II, time to treatment, margins, lymph nodes, mortality, and surgical volume with a maximum possible score 10. The QI increased over time: 3 in Group 1; 4 in Group 2; and 6 in Group 3. An improvement was noted for the quality indicators: surgical resection (P = 0.0125) and use of palliative and adjuvant therapy (P = 0.0144 and < 0.0001). Implementation of a focused multidisciplinary pancreatic surgery program increases quality.
authors.affiliation: Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA. fitzgeraldt@ecu.edu
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.forename: Noah M
authors.initials: NM
authors.lastname: Seymore
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
authors.forename: Jan H
authors.initials: JH
authors.lastname: Wong
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010180:Pancreatectomy / Q000401:mortality / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome