title: The impact of organisational external peer review on colorectal cancer treatment and survival in the Netherlands.
abstract: BACKGROUND
  Organisational external peer review was introduced in 1994 in the Netherlands to improve multidisciplinary cancer care. We examined the clinical impact of this programme on colorectal cancer care.
  
  
  METHODS
  Patients with primary colorectal cancer were included from 23 participating hospitals and 7 controls. Hospitals from the intervention group were dichotomised by their implementation proportion (IP) of the recommendations from each peer review (high IP vs low IP). Outcome measures were the introduction of new multidisciplinary therapies and survival.
  
  
  RESULTS
  In total, 45 705 patients were included (1990-2010). Patients from intervention hospitals more frequently received adjuvant chemotherapy for stage III colon cancer. T2-3/M0 rectal cancer patients from hospitals with a high IP had a higher chance of receiving preoperative radiotherapy (OR 1.31, 95% CI 1.11-1.55) compared with the controls and low IP group (OR 0.75, 95% CI 0.63-0.88). There were no differences in the use of preoperative chemoradiation for T4/M0 rectal cancer. Survival was slightly higher in colon cancer patients from intervention hospitals but unrelated to the phase of the programme in which the hospital was at the time of diagnosis.
  
  
  CONCLUSIONS
  Some positive effects of external peer review on cancer care were found, but the results need to be interpreted cautiously due to the ambiguity of the outcomes and possible confounding factors.
authors.affiliation: 1] Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands [2] Department of Health Technology and Services Research, School for Management and Governance, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kilsdonk
authors.affiliation: 1] Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands [2] Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: B A C
authors.initials: BA
authors.lastname: van Dijk
authors.affiliation: Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Otter
authors.affiliation: 1] Department of Research, Comprehensive Cancer Centre the Netherlands, Postbus 19079, 3501 DB Utrecht, The Netherlands [2] Department of Health Technology and Services Research, School for Management and Governance, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Siesling
authors.affiliation: 1] Department of Health Technology and Services Research, School for Management and Governance, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands [2] Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: van Harten
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018024:Peer Review, Health Care