Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan
1 Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
2 Center for Health Insurance Research, College of Public Health, National Taiwan University, Taipei, Taiwan
3 Department of General Surgery, Zhong-Siao Branch, Taipei City Hospital, Taipei, Taiwan
4 Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
5 Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
6 Department of Internal Medicine, National Chung-Kung University Hospital, Tainan, Taiwan
7 Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
8 Division of Cancer Research, National Health Research Institutes, Taiwan
9 Department of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
BMC Health Services Research 2010, 10:27 doi:10.1186/1472-6963-10-27Published: 27 January 2010
Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance.
The development of core measures for colorectal cancer has undergone three stages including a modified Delphi method. The study sample originated from 2004 data in the Taiwan Cancer Database, a national cancer data registry. Eighteen hospitals and 5585 newly diagnosed colorectal cancer patients were enrolled in this study. We used indicator-based and case-based approaches to examine adherences simultaneously.
The final core measure set included seventeen indicators (1 pre-treatment, 11 treatment-related and 5 monitoring-related). There were data available for ten indicators. Indicator-based adherence possesses more meaningful application than case-based adherence for hospital comparisons. Mean adherence was 85.8% (79.8% to 91%) for indicator-based and 82.8% (77.6% to 88.9%) for case-based approaches. Hospitals performed well (>90%) for five out of eleven indicators. Still, the performance across hospitals varied for many indicators. The best and poorest system performance was reflected in indicators T5-negative surgical margin (99.3%, 97.2% - 100.0%) and T7-lymph nodes harvest more than twelve(62.7%, 27.6% - 92.2%), both of which related to surgical specimens.
In this nationwide study, quality of colorectal cancer care still shows room for improvement. These preliminary results indicate that core measures for cancer can be developed systematically and applied for internal quality improvement.