title: Novel quality indicators for metastatic colorectal cancer management identify significant variations in these measures across treatment centers in Australia.
abstract: OBJECTIVE
  Defining multidisciplinary quality of care indicators (QCIs) for metastatic colorectal cancer (mCRC) could improve understanding of variations in routine practice care. This may identify areas of below-average performance, which could then be addressed by clinicians to improve the quality of care delivered. This study aimed to define a panel of QCIs in mCRC and, based on these QCIs, to evaluate quality of care across multiple Australian sites.
  
  
  METHODS
  A panel of clinicians with expertise in colorectal cancer defined evidence-based or best practice-based QCIs relevant to the routine multidisciplinary management of mCRC patients through structured consensus discussion. Related data were extracted from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry, a prospectively maintained database recording comprehensive details on consecutive mCRC patients across multiple Australian hospitals. Variations in QCIs across sites were explored.
  
  
  RESULTS
  Of 13 QCIs defined, data related to 10 were reliably extracted from TRACC. Analysis of data on 1276 patients across 10 sites demonstrated low rates of screening for hereditary nonpolyposis colorectal cancer in young patients and significant variation in surveillance-detected recurrences, lung resection rates and palliative chemotherapy use. Exploratory analyses suggested correlation between liver resection rates and survival.
  
  
  CONCLUSIONS
  We have defined a novel set of mCRC QCIs and have demonstrated wide variation in the quality of care of mCRC across multiple Australian sites. With further validation to confirm a direct correlation between QCI and patient outcomes, these QCIs could be applied to improve the quality of care received by all mCRC patients.
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Natalie Heather
authors: NH
authors: Turner
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
authors: Hui-Li
authors: HL
authors: Wong
authors: Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Kathryn
authors: K
authors: Field
authors: Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia.|Eastern Health Medical School, Monash University, Melbourne, Victoria, Australia.
authors: Rachel
authors: R
authors: Wong
authors: Cabrini Health, Melbourne, Victoria, Australia.
authors: Jeremy
authors: J
authors: Shapiro
authors: The Canberra Hospital, Canberra, Australian Capital Territory, Australia.|Calvary Hospital, Canberra, Australian Capital Territory, Australia.|ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Desmond
authors: D
authors: Yip
authors: Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors: Louise
authors: L
authors: Nott
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Hospital, Melbourne, Victoria, Australia.
authors: Jeanne
authors: J
authors: Tie
authors: Department of Medical Oncology, Western Hospital, Melbourne, Victoria, Australia.
authors: Suzanne
authors: S
authors: Kosmider
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Medical Oncology, Western Hospital, Melbourne, Victoria, Australia.
authors: Ben
authors: B
authors: Tran
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Jayesh
authors: J
authors: Desai
authors: Department of Medical Oncology, Eastern Health, Melbourne, Victoria, Australia.
authors: Joseph
authors: J
authors: McKendrick
authors: Epworth Hospital, Melbourne, Victoria, Australia.
authors: Allan
authors: A
authors: Zimet
authors: Cabrini Health, Melbourne, Victoria, Australia.
authors: Gary
authors: G
authors: Richardson
authors: Goulburn Valley Health, Shepparton, Victoria, Australia.|University of Melbourne Rural Health Academic Centre, Shepparton, Victoria, Australia.
authors: Mahesh
authors: M
authors: Iddawela
authors: The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|BioGrid Australia, Melbourne, Victoria, Australia.|Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors: Peter
authors: P
authors: Gibbs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D019984:Quality Indicators, Health Care; D055815:Young Adult
keywords: Australia; colorectal neoplasms; quality indicators; quality of health care; registries