TY - JOUR
T1 - Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer
AU - Galvan-Turner, Valerie B.
AU - Chang, Jenny
AU - Ziogas, Argyrios
AU - Bristow, Robert E.
N1 - Funding Information:
Dr. Bristow was supported in part by an unrestricted research grant from the T32 CA-060396-11). Funding sources had no involvement with the study design, data collection, analysis and interpretation of data, and in the writing of this manuscript or decision to submit this paper for publication. Queen of Hearts Foundation and supported by National Institutes of Health T-32 training grant (Ruth L. Kirschstein National Research Service Award Institutional Training Research Grant, 2
Publisher Copyright:
© 2015 Published by Elsevier Inc.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Objective To develop an observed-to-expected ratio (O/E) for adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines as a risk-adjusted hospital measure of quality care correlated with disease-specific survival. Methods Consecutive patients with stages I-IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96-12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume < 5, middle two O/E quartiles and volume ≥ 5, and highest O/E quartile and volume ≥ 5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival. Results Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n = 285) treated 4661 patients (25.2%), mean O/E = 0.77 ± 0.55 and median survival 38.9 months (95%CI = 36.2-42.0 months). Intermediate O/E hospitals (n = 85) treated 8715 patients (47.1%), mean O/E = 0.87 ± 0.17 and median survival of 50.5 months (95% CI = 48.4-52.8 months). Highest O/E hospitals (n = 35) treated 5115 patients (27.7%), mean O/E = 1.34 ± 0.14 and median survival of 53.8 months (95% CI = 50.2-58.2 months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR = 1.06, 95% CI = 1.01-1.11) and lowest O/E (1.16, 95% CI = 1.10-1.23) hospitals. Conclusions Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival.
AB - Objective To develop an observed-to-expected ratio (O/E) for adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines as a risk-adjusted hospital measure of quality care correlated with disease-specific survival. Methods Consecutive patients with stages I-IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96-12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume < 5, middle two O/E quartiles and volume ≥ 5, and highest O/E quartile and volume ≥ 5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival. Results Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n = 285) treated 4661 patients (25.2%), mean O/E = 0.77 ± 0.55 and median survival 38.9 months (95%CI = 36.2-42.0 months). Intermediate O/E hospitals (n = 85) treated 8715 patients (47.1%), mean O/E = 0.87 ± 0.17 and median survival of 50.5 months (95% CI = 48.4-52.8 months). Highest O/E hospitals (n = 35) treated 5115 patients (27.7%), mean O/E = 1.34 ± 0.14 and median survival of 53.8 months (95% CI = 50.2-58.2 months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR = 1.06, 95% CI = 1.01-1.11) and lowest O/E (1.16, 95% CI = 1.10-1.23) hospitals. Conclusions Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival.
KW - Hospitals
KW - Humans
KW - Ovarian cancer
KW - Quality measurement
KW - Risk assessment
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U2 - 10.1016/j.ygyno.2015.09.015
DO - 10.1016/j.ygyno.2015.09.015
M3 - Article
C2 - 26387962
AN - SCOPUS:84949647396
VL - 139
SP - 495
EP - 499
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 3
ER -