title: Does Quality of Care Matter? A Study of Adherence to National Comprehensive Cancer Network Guidelines for Patients with Locally Advanced Esophageal Cancer.
abstract: BACKGROUND
  The aim of this study was to assess whether adherence to National Comprehensive Cancer Network (NCCN) guidelines leads to differences in survival in patients diagnosed with locally advanced esophageal cancer.
  
  
  METHODS
  This is a retrospective cohort study of patients with stage II and III esophageal cancer included in the Cancer Registry at the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital from 2008 to 2013. Seven quality indicators were identified using the 2014 NCCN guidelines, and individual and overall quality measure scores were calculated and used to define low and high quality of care groups.
  
  
  RESULTS
  One hundred forty-one patients met inclusion criteria, and 88 patients (62.4 %) were identified as receiving high-quality care. Adherence to guidelines ranged from 63.1 to 100.0 %, with an overall compliance of 81.3 %. Risk factors for receiving low quality of care included advanced age, non-white race, lower education level, and unspecified primary site of tumor. A significantly better overall survival was observed in patients who received high-quality care (HR, 0.58; 95 %, 0.37-0.90, p = 0.015).
  
  
  CONCLUSIONS
  Delivery of high-quality care is associated with improved survival in these patients. Efforts should be directed at minimizing disparities in treatment in regards to race and educational levels.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA. dmolena2@jhmi.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Miloslawa
authors.initials: M
authors.lastname: Stem
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Poupore
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sophia Y
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States
keywords: Esophageal cancer; NCCN guidelines; Quality of care; Survival