title: Variation in guideline adherence in non-Hodgkin's lymphoma care: impact of patient and hospital characteristics.
abstract: BACKGROUND
  The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin's lymphoma (NHL) care.
  
  
  METHODS
  Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data.
  
  
  RESULTS
  Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain. Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner.
  
  
  CONCLUSIONS
  Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands. JozetteStienen@gmail.com.
authors.forename: Jozette J C
authors.initials: JJ
authors.lastname: Stienen
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands. Rosella.Hermens@Radboudumc.nl.
authors.forename: Rosella P M G
authors.initials: RP
authors.lastname: Hermens
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands. Lianne.Wennekes@Radboudumc.nl.
authors.forename: Lianne
authors.initials: L
authors.lastname: Wennekes
authors.affiliation: Netherlands Comprehensive Cancer Organisation, Department of Registry and Research, PO box 19079, 3501 DB, Utrecht, the Netherlands. sam_vd_schans@hotmail.com.
authors.forename: Saskia A M
authors.initials: SA
authors.lastname: van de Schans
authors.affiliation: Department of Radiotherapy, Radboud university medical center, Nijmegen, the Netherlands. Richard.vanderMaazen@Radboudumc.nl.
authors.forename: Richard W M
authors.initials: RW
authors.lastname: van der Maazen
authors.affiliation: Department of Radiology, Radboud university medical center, Nijmegen, the Netherlands. Heleen.Dekker@Radboudumc.nl.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Dekker
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands. Janine.Liefers@Radboudumc.nl.
authors.forename: Janine
authors.initials: J
authors.lastname: Liefers
authors.affiliation: Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands. Han.vanKrieken@Radboudumc.nl.
authors.forename: Johan H J M
authors.initials: JH
authors.lastname: van Krieken
authors.affiliation: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands. Nicole.Blijlevens@Radboudumc.nl.
authors.forename: Nicole M A
authors.initials: NM
authors.lastname: Blijlevens
authors.affiliation: Department of Medical Oncology, Radboud university medical center, Nijmegen, the Netherlands. Nelleke.Ottevanger@Radboudumc.nl.
authors.forename: Petronella B
authors.initials: PB
authors.lastname: Ottevanger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000592:standards; D019984:Quality Indicators, Health Care; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D055815:Young Adult