Background
Methods
Patient data
Patient matching
Quality indicators and their computation
1. | Dutch Surgical Colorectal Audit (Process) |
---|---|
Numerator
| Number of surgical resections of colorectal carcinomas located in colon or rectum (only count resections for primary carcinomas) |
for which data has been submitted to the Dutch Surgical Colorectal Audit | |
Denominator
| Number of surgical resections of colorectal carcinomas located in colon or rectum (only count resections for primary carcinomas) |
Inclusion
| Primary carcinomas |
Exclusion
| Recurrent colorectal carcinomas; TEM-resection (transanal endoscopic microsurgery) |
2.
|
Number of lymph nodes examined after resection (Process)
|
Numerator
| Number of patients who had 10 or more lymph nodes examined after resection of a primary colonic carcinoma |
Denominator
| Number of patients who underwent resection of a primary colonic carcinoma |
Inclusion
| All primary carcinomas, for which a part of the colon has been resected via open or laparoscopic surgery |
Exclusion
| 1) patients who had a ‘resection’ via colonoscopy; 2) patients with previous radiotherapy; 3) patients with a recurrent carcinoma |
3.
|
Patients with rectum carcinoma discussed in multidisciplinary meeting before surgery (Process)
|
Numerator
| Number of patients with rectum carcinoma who have been discussed in a multidisciplinary meeting before the surgery |
Denominator
| Number of patients with rectum carcinoma operated in reporting year |
Inclusion
| All patients who underwent a resection of rectum due to a primary rectum carcinoma in the reporting year, via open or |
laparoscopic surgery | |
Exclusion
| TEM-resections and recurrent rectum carcinoma |
4.
|
Preoperative imaging colon (Process)
|
Numerator
| Number of patients with diagnosed colorectal carcinoma which has been resected electively en whose colon has been imaged |
completely before the surgery | |
Denominator
| Number of patients with diagnosed colorectal carcinoma which has been resected electively |
Inclusion
| All primary carcinomas, for which a part of the colon has been resected via open or laparoscopic surgery |
Exclusion
| 1) patients who had a ‘resection’ via colonoscopy; 2) patients with previous radiotherapy; 3) patients with a recurrent carcinoma |
5.
|
Adjuvant chemotherapy colonic carcinoma (Process)
|
Numerator 5a
| Number of patients < 75 years old with a resected stage III (N1-2 M0) colonic carcinoma who received adjuvant chemotherapy |
Denominator 5a
| Number of patients < 75 years old with a resected stage III colonic carcinoma |
Numerator 5b
| Number of patients ≥ 75 years old with a resected stage III (N1-2 M0) colonic carcinoma who received adjuvant chemotherapy |
Denominator 5b
| Number of patients ≥ 75 years old with a resected stage III colonic carcinoma |
Inclusion
| All primary carcinomas, for which a part of the colon has been resected via open or laparoscopic surgery, and which have been |
classified as stage III in an postoperative pathology examination | |
Exclusion
| 1) patients who had a ‘resection’ via colonoscopy; 2) patients with a recurrent carcinoma |
6.
|
CRM rectum carcinoma (6a: Process, 6b: Outcome)
|
Numerator 6a
| Number of patients with a resected primary rectum carcinoma for which the CRM (circumferential resection margin) has been |
included in the pathology report and registered in the DSCA | |
Denominator 6a
| Number of patients with a resected primary rectum carcinoma |
Numerator 6b
| Number of patients with rectum carcinoma with a CRM of 1 mm or less (tumor positive) |
Denominator 6b
| Number of patients with a resected primary rectum carcinoma |
Inclusion
| All patients who underwent a resection of rectum due to a primary rectum carcinoma in the reporting year, via open or |
laparoscopic surgery | |
Exclusion
| TEM-resections and recurrent rectum carcinoma |
7.
|
Preoperative radiotherapy rectum carcinoma (Process)
|
Numerator
| Number of patients with T3 or T4 rectum carcinoma who received preoperative radiotherapy |
Denominator
| Number of patients with T3 or T4 rectum carcinoma |
Inclusion
| - |
Exclusion
| - |
8.
|
Volume (8a: Structure, 8b: Process)
|
Indicator 8a
| How many surgeons does the team include and how many of these surgeons carry out resections on primary colonic carcinoma |
patients? | |
Indicator 8b
| Number of resections of primary colonic carcinomas |
Inclusion
| - |
Exclusion
| - |
Outcome measures
Quality indicators
Data quality
Results
Patient matching
Computation of quality indicators
Indicator | DSCA | EMR | Sensitivity | Specificity | PPV | NPV | PLR | NLR |
---|---|---|---|---|---|---|---|---|
1 DSCA
| (75/-) | (-/79) | - | - | - | - | - | - |
2 lymph nodes | 85% (39/46) | (-/36) | - | - | - | - | - | - |
3 meeting | 100% (29/29) | 70% (23/33) | 79% (23/29) | - (0/0) | 100% (23/23) | 0% (0/10) | - | - |
4 imaging | 88% (36/41) | 58% (31/53) | 58% (21/36) | 60% (3/5) | 67% (21/31) | 14% (3/44) | 1,45 | 0,7 |
5a chemotherapy | 80% (8/10) | - | - | - | - | - | - | - |
5b chemotherapy | 17% (1/6) | - | - | - | - | - | - | - |
6a CRM
| 62% (18/29) | (-/33) | - | - | - | - | - | - |
6b CRM | 14% (4/29) | (-/33) | - | - | - | - | - | - |
7 radiotherapy | 92% (22/24) | - | - | - | - | - | - | - |
8b volume | 46 | 37 | - | - | - | - | - | - |
Comparison of selected patients
Indicator | Element | DSCA | EMR | |||
---|---|---|---|---|---|---|
EMR | TP (DSCA and EMR) | FP (DSCA only) | FN (EMR only) | |||
1 DSCA | Num/denom | 75 | 79 | 63 | 12 | 16 |
2 nodes | Denominator | 46 | 36 | 28 | 18 | 8 |
3 meeting | Numerator | 29 | 23 | 23 | 6 | 0 |
3 meeting | Denominator | 29 | 33 | 25 | 4 | 8 |
4 imaging | Numerator | 36 | 31 | 21 | 15 | 10 |
4 imaging | Denominator | 41 | 53 | 31 | 10 | 22 |
6a and 6b CRM | Denominator | 29 | 33 | 25 | 4 | 8 |
8b volume | - | 46 | 37 | 28 | 18 | 9 |
Outcome measures
Quality indicators
Data quality
Item | Completeness DSCA | Completeness EMR | Correctness |
---|---|---|---|
Operation date | 100% (75) | 100% (75) | 100% (75) |
Year of birth | 100% (75) | 100% (75) | 100% (75) |
Procedure | 100% (75) | 100% (75) | 97% (73/75) |
Operation urgency | 100% (75) | 100% (75) | 95% (71/75) |
Primary location/Diagnosis | 100% (75) | 100% (75) | 91% (68/75) |
cT score | 39% (29) | 0% (unavailable) | - |
pN stage | 100% (75) | 0% (unavailable) | - |
pM stage | 100% (75) | 0% (unavailable) | - |
Examined lymph nodes | 99% (74) | 0% (unavailable) | - |
Circumferential margin | 24% (18) | 0% (unavailable) | - |
[Colonoscopy] | [100% (75)] | [80% (60)] | 83% (50/60) |
[Chemotherapy/Medication] | [99% (74)] | [97% (73)] | 21% (15/73) |
[Meeting date] | [85% (64)] | [79% (59)] | 98% (57/58) |
[Radiotherapy start date] | [33% (25)] | [24% (18)] | 100% (18/18) |
Average of available items | 86% | 50% | 87% |
Catalogue of encountered problems
Problem | Explanation |
---|---|
Data not available in | Data items required to compute many of the indicators, such as those contained in the pathology reports, were only |
structured format | available in non-structured free text, and therefore not directly (re)usable. Also structured data to exclude patients based on |
the exclusion criteria recurrent carcinoma and TEM-resection as well as ‘resection’ via colonoscopy was not available in our EMR | |
nor in the DSCA dataset. Non-recorded exclusion criteria can lead to lower indicator results, wrongly underestimating the | |
Incorrect data items | The double data entry in our case study helped us to discover incorrect data items. Furthermore, we identified imprecise |
and/or incorrect diagnosis codes in our EMR. | |
Incomplete view of | Hospitals throughout the country refer patients to our hospital, which specialises in gastro-intestinal oncology. Some of |
patient history | these patients are only treated for a short time, and then referred back. Likewise, our hospital maintains an alliance with a |
nearby hospital. Referral letters are typically posted as physical letters, making a complete, consistent view on a patient’s | |
history difficult to obtain. For example, it is hard to retrace whether preoperative imaging of the colon has taken place in | |
another hospital. | |
Lack of relations | Our EMR does not store any relations between diagnoses and procedures, making it impossible to select the diagnosis that |
between data items | was the underlying reason for a procedure. For example, the lymph node indicator should only select lymph node |
examinations that have been carried out in the context of a primary colonic carcinoma, and not, for example, a previous | |
mamma carcinoma. As a partial solution, we imposed the constraint that the diagnosis should have been established before | |
the related operation was carried out, which resulted in some missed patients. | |
Lack of detail | None of the diagnoses in the EMR was detailed enough to meet the information required by the indicators, which include |
patients with primary colonic and rectum carcinomas. The only relevant diagnoses in the EMR were malignant neoplasm | |
of colon, rectum and rectosigmoid junction. Therefore, the concepts employed in the queries to compute the indicators | |
had to be generalised. Furthermore, only the type of endoscopies is registered, such as colonoscopy, but not whether the | |
complete colon is affected. | |
Lack of standardisation | For example, the urgency of an operation is defined in the EMR according to 8 categories, but the DSCA dataset only |
differentiates urgencies according to 4 categories. It was not clear how these categories should be mapped, as their | |
meaning was not unambiguously described (for example, one of the categories was called “extra”). |