title: Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma.
abstract: OBJECTIVE
  The aim of this population-based study was to evaluate the impact of quality indicators on the adherence to guidelines for renal cell carcinoma (RCC).
  
  
  METHODS
  Since 2005, virtually all patients with newly diagnosed RCC in Sweden have been registered in the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence and survival. In addition, a number of quality indicators have been measured in the register aiming to increase the quality of care. The quality indicators are: the coverage of the register, histology reports, preoperative chest computed tomography (CT), partial nephrectomy, laparoscopic surgery, centralization to high-volume hospitals and waiting times.
  
  
  RESULTS
  A total of 8556 patients with diagnosed RCC were registered from 2005 to 2013 (99% coverage). In 2013, 99% of the histopathology reports were standardized. The number of patients with preoperatively chest CT increased from 59% in 2005 to 89% in 2013. The proportion of patients with RCC T1aN0M0 who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2013. Similarly, laparoscopic radical nephrectomies increased from 6% in 2005 to 24% in 2013. The median tumour size at detection decreased from 60 mm in 2005 to 55 mm in 2013. The proportion of patients who were incidentally detected increased from 43% in 2005 to 55% in 2013.
  
  
  CONCLUSIONS
  The data show an improved adherence to the guidelines for RCC as measured by quality indicators and a steady process of earlier detection of patients with RCC.
authors.affiliation: a 1 Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University , Umeå, Sweden.|b 2 Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute , Stockholm, Sweden.|c 3 Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford , Oxford, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Thorstenson
authors.affiliation: d 4 Department of Oncology, Karolinska University Hospital , Solna, Stockholm, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Harmenberg
authors.affiliation: e 5 Department of Urology, Department of Urology, Faculty of Medicine and Health, Örebro University , Örebro, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lindblad
authors.affiliation: a 1 Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University , Umeå, Sweden.
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.affiliation: f 6 Department of Urology, Sahlgrenska University Hospital , Göteborg, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Lundstam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D019468:Disease Management; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D013902:Radiography, Thoracic; D012042:Registries; D013548:Sweden; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D055815:Young Adult
keywords: Population-based; Sweden; quality indicators; renal cell carcinoma; surgery; tumour size; tumour type