Defining Surgical Quality in Gastric Cancer: A RAND/UCLA Appropriateness Study (original) (raw)
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Quality of Care Indicators for the Surgical Treatment of Gastric Cancer: A Systematic Review
Annals of Surgical Oncology, 2013
Background Quality assurance is increasingly acknowledged as a crucial factor in the (surgical) treatment of gastric cancer. The aim of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer. Methods A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on locally advanced gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence, and were grouped into structure, process, and outcome indicators. Results A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection. Conclusions Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.
Quality of gastric cancer care in designated cancer care hospitals in Japan
International Journal for Quality in Health Care, 2013
Objective. To develop a set of process-of-care quality indicators (QIs) that would cover a wide range of gastric cancer care modalities and to examine the current state of the quality of care provided by designated cancer care hospitals in Japan. Design. A retrospective medical record review. Settings. Eighteen designated cancer care hospitals throughout Japan. Participants. A total of 1685 patients diagnosed with gastric cancer in 2007. Main Outcome Measures. Provision of care to eligible patients as described in the 29 QIs, which were developed using an adaptation of the RAND/UCLA (University of California, Los Angeles) appropriateness method by a panel of nationally recognized experts in Japan. Results. Overall, the patients received 68.3% of the care processes recommended by the QIs. While 'deep venous thrombosis prophylaxis before major surgery' was performed for 99% of the cases, 'documentation before endoscopic resection' was completed for only 12% of the cases. The chemotherapy care was less likely to meet the QI standards (61%) than pre-therapeutic care (76%), surgical treatment (66%) and endoscopic resection (71%; overall difference: P < 0.001). A comparison based on the types of care showed that documentation and patient explanation were performed less frequently (60 and 53%, respectively) than were diagnostic and therapeutic processes as recommended in the QIs (85%; overall P < 0.001). Conclusions. Although many required care processes were provided, some areas with room for improvement were revealed, especially with respect to chemotherapy, documentation and patient explanation. Continuous efforts to improve the quality and develop a system to monitor this progress would be beneficial in Japan.
Annals of Gastroenterological Surgery, 2019
The Japanese Society of Gastroenterological Surgery (JSGS) and the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) have collaboratively developed several clinical projects since 2011 using two nationwide clinical registries with the goal of achieving further improvement of surgical quality in both countries. In this review, the historical viewpoints and the collaboration between JSGS and ACS and their use of nationwide registries [National Clinical Database (NCD) and NSQIP] for research are reviewed. We have carried out a joint project, the 30‐day Mortality Risk Model Study and, currently, we are working on several joint projects such as the Morbidity‐Mortality Study, Japan‐USA Calibration Study, Geriatric Study, and Safety Culture Study as well as Auditing in JSGS/NCD with reference to the NSQIP method. These joint projects will continue to provide us with important information and data to drive improvements in surgical care in both countries....
Polski przeglad chirurgiczny, 2011
The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer...
Annals of gastroenterological surgery, 2018
Benchmarking has proven beneficial in improving the quality of surgery. Mortality rate is an objective indicator, of which the 30-day mortality rate is the most widely used. However, as a result of recent advances in medical care, the 30-day mortality rate may not cover overall surgery-related mortalities. We examined the significance and validity of the 30-day mortality rate as a quality indicator. The present study was conducted on cancer surgeries of esophagectomy, total gastrectomy, distal gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, and pancreaticoduodenectomy that were registered in the first halves of 2012, 2013 and 2014 in a Japanese nationwide large-scale database. This study examined the mortality curve for each surgical procedure, "sensitivity of surgery-related death" (capture ratio) at each time point between days 30-180, and the association between mortality within 30 days, mortality after 31 days, and preoperative, perioperative, an...
Quality Assessment in Surgery- Conceptual Framework
Journal of Bangladesh College of Physicians and Surgeons, 2020
'Quality' is a popular demand in health care. Surgeons as professionals are consistently putting their efforts to meet this demand. The standard and dimensions of 'quality' are changing and expectations are rising along with social reforms driven by scientific and economic growth. On the other hand, objective assessment of care in surgical patients is difficult and dependent on factors that are not precisely related to surgical skills. It is rather performance of all in the organization and sum of each and every human and system effort. In this effort we will discuss factors related to surgical care quality and different methods of assessment and their limitations. For quality surgical care, good intent, enabling environment with organized supportive system is required with skilled surgical team and meticulous monitoring system along the care process.
Quality Indicators for Gastric Cancer Surgery: A Survey of Practicing Pathologists in Ontario
Annals of Surgical Oncology, 2009
Background. Adequate lymph node (LN) assessment and R0 resection are critical to the staging and management of gastric cancer. The American Joint Committee on Cancer/ International Union Against Cancer recommend at least 15 LN be assessed, and the literature suggests a gross diseasefree margin of 5-6 cm be achieved. Results of an Ontario general surgeons' survey indicated these standards were not widely known. Because disease management is highly collaborative, we surveyed pathologists to assess their knowledge of LN assessment and margins for processing gastric cancer specimens. Methods. Pathologists were identified by the College of Physicians and Surgeons of Ontario and MD Select databases. Participants were surveyed online or by mail. Results. Pathologists indicated a goal of assessing \5 LN (2%), 5-10 LN (27%), 10-15 LN (40%), 15-20 LN (20%), or [20 LN (11%). Most self-reported an actual assessment of 5-10 LN (49%), with 88% reporting a number below current standards. Additionally, 54% of responding pathologists identified [1 cm as an adequate gross margin, and 89% of pathologists indicated a response below current standards. Ninety-four percent of pathologists agreed that more education on gastric cancer is valuable.
Current oncology (Toronto, Ont.), 2014
Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. The expert panel consisted of 22 participants. Experts confirmed that spits were an important strateg...
Journal of the Royal Society of Medicine, 2007
There is increasing interest in evaluating the quality of care delivered by health care providers and its impact on the overall satisfaction of the end-user, namely the patient. Despite the political incentives that such research evokes, important questions surrounding this topic must be answered to improve the way in which care is delivered. This signals important changes in the way that patients, clinicians, scientists and administrators, evaluate outcomes of treatment.