Background
Methods
Patients and hospitals
Core measures development
Comparisons across hospitals
Results
Patient and disease characteristics
Gender | Age (years) | |||||||
---|---|---|---|---|---|---|---|---|
Male | Female | <30 | 31-40 | 41-50 | 51-60 | >60 | Total | |
stage 0 | 97 | 60 | 2 | 7 | 22 | 38 | 88 | 78(1.4%)* |
stage 1 | 463 | 324 | 6 | 27 | 65 | 167 | 522 | 787(14.1%)* |
stage 2 | 811 | 580 | 15 | 49 | 142 | 229 | 956 | 1,391(24.9%)* |
stage 3 | 960 | 711 | 14 | 94 | 200 | 340 | 1023 | 1,671(29.9%)* |
stage 4 | 633 | 488 | 31 | 61 | 164 | 219 | 676 | 1,151(20.6%)* |
unspecified stage | 263 | 165 | 10 | 19 | 44 | 75 | 280 | 428(7.7%)* |
3257 (58.3%)#
| 2328 (41.7%)#
| 157 (2.8%)#
| 257 (4.6%)#
| 637 (11.4%)#
| 1068 (19.1%)#
| 3545 (63.5%)#
| 5585 (100%) |
Core measures
Indicator | Description | Numerator | Denominator | Evidence level or grade of recommendation | Rationale |
---|---|---|---|---|---|
PT1 | Proportion of colorectal patients who have pre-operative chest X-ray and abdominal ultrasound, CT scan or MRI18
| Number of colorectal patients who have pre-operative chest x-ray and abdominal ultrasound, CT scan or MRI (including off-site) | Number of all colorectal patients | Grade C | Comprehensive-ness of pre-operative evaluation |
T1 | Proportion of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy was offered within 6 months before or after surgery19,20
| Number of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy (including off-site) was offered within 6 months before or after surgery | Number of colorectal patients who have undergone surgical resection for colon or rectal cancer | Level II-2 | Synchronous colon or rectal cancer |
T2* | Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated19
| Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated | Number of colorectal patients who pathological report for malignant polyp of colon or rectum revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated | Level II-2, III | Increase curability |
T3a | Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital)19,23
| Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital) | Number of patients who are diagnosed with colon cancer and do not have metastatic disease. (For patient with diagnosis and treatment of care in the same hospital) | Level II-2, III | Improve survival |
T3b | Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis19,23
| Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis | Number of patients who are diagnosed with colon cancer and do not have metastatic disease | Level II-2, III | Improve Survival |
T4 | Proportion of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved21, 22
| Number of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved | Number of stage I to III colorectal patients excluding patients undergo polypectomy | Grade B | Provide information for subsequent intervention, which related to tumor recurrence |
T5 | Proportion of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins"19,23
| Number of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins" | Number of stage I to III colorectal patients excluding no pathological report regarding status of margin | Level II-2, III | Radical excision |
T6 | Proportion of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation22,24
| Number of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation | Number of colorectal patients who undergo a surgery | Class B | Provide information for subsequent intervention and follow-up |
T7 | Proportion of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report25
| Number of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report | Number of I to III stage colorectal cancer patients excluding polypectomy, or neo-radiotherapy | Level III or IV | Radical excision and pathological accountability |
T8* | Proportion of pathological report according to CAP checklist or similar one21,26
| Number of pathological report according to CAP checklist or similar one | Number of colorectal patients | Pathological report comprehensiveness | |
T9 | Proportion of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery19,27,28
| Number of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery | Number of stage III colon cancer patients who was offered chemotherapy after surgery (in the same hospital) | Level I, II-2, III | Increase Survival |
T10 | Proportion of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis19,24
| Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis | Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment in the same hospital | Level II-2, III | Avoid treatment delay |
T11 | Proportion of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT19,23
| Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT | Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered CCRT before surgery | Level II-2, III | Provide treatment for cure intent |
F1* | Proportion of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion19,29
| Number of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion | Number of patients who had completed all courses of therapy for Stage I to III lesions | Level II-2, III | Decrease mortality |
F2* | Proportion of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval19
| Number of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval | Number of patients who had Stage I to III lesions | Level II-2, III | Decrease recurrence |
F3* | Proportion of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure19,30
| Number of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure | Number of patients who are treated by polypectomy procedure for malignant polyp | Level III | Decrease recurrence |
F4* | Five-year over-all survival rate, stage specific (Stage I to IV)28
| Number of patients who survive at five-year period, stage specific (Stage I to IV) | Number of patients, stage specific (Stage I to IV) | Class C | Assess survival |
F5* | Five-year local recurrence rate, stage specific (Stage I to III)18
| Number of patients who had recurrence at five-year period, stage specific (Stage I to III) | Number of patients, stage specific (Stage I to III) | Grade B | Assess recurrence |
Hospital performances and comparisons
Hospitals\Performance | Indicator-based | Case-based | |||||
---|---|---|---|---|---|---|---|
Adherence1* | Hospital score1#
| Hospital score2#
| Hospital score3#
| Adherence2* | |||
% | (95 CI) | % | (95 CI) | ||||
H01§
| 86.5 | (79.4-93.7) | 5 | 2 | 2 | 83.5 | (80.4-86.7) |
H02 | 87.1 | (79.3-95.0) | 5 | 5 | 2 | 84.2 | (82.4-86.0) |
H03 | 82.3 | (68.9-95.8) | 6 | 4 | 2 | 79.8 | (76.7-82.9) |
H04 | 82.4 | (70.3-94.6) | 5 | 4 | 4 | 79.7 | (77.2-82.1) |
H05 | 88.8 | (82.2-95.4) | 7 | 3 | 1 | 86.1 | (82.7-89.5) |
H06 | 85.7 | (76.3-95.1) | 6 | 4 | 4 | 88.1 | (85.3-90.9) |
H07 | 90.2 | (83.0-97.4) | 8 | 6 | 4 | 85.6 | (82.3-89.0) |
H08 | 91.0 | (83.2-98.7) | 8 | 6 | 3 | 88.9 | (87.8-90.1) |
H09 | 85.9 | (77.5-94.3) | 4 | 3 | 1 | 81.2 | (78.5-83.9) |
H10 | 86.1 | (78.2-94.0) | 6 | 4 | 4 | 84.7 | (82.6-86.9) |
H11 | 79.8 | (67.7-91.9) | 2 | 0 | 0 | 79.4 | (77.5-81.3) |
H12 | 84.7 | (75.0-94.5) | 4 | 1 | 1 | 82.2 | (79.7-85.3) |
H13 | 88.9 | (82.1-95.7) | 6 | 4 | 2 | 84.1 | (80.4-87.7) |
H14 | 85.3 | (76.3-94.2) | 6 | 6 | 3 | 85.4 | (82.6-88.1) |
H15 | 82.4 | (74.1-90.7) | 3 | 0 | 0 | 80.7 | (78.4-83.1) |
H16 | 81.8 | (71.3-92.4) | 4 | 4 | 2 | 77.6 | (73.0-82.1) |
H17 | 85.0 | (73.8-96.1) | 6 | 3 | 2 | 78.7 | (75.1-82.3) |
H18 | 86.6 | (76.9-96.3) | 5 | 4 | 3 | 81.6 | (79.6-83.7) |
Mean | 85.8 | (78.3-93.3) | 5.3 | 3.5 | 2.2 | 82.8 |
Discussion
Conclusions
Appendix
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MD, PhD, Professor, Department of Medicine, National Taiwan University Hospital;
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MD, PhD, Associate Professor, Department of Surgery, National Taiwan University Hospital;
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MD, PhD, Department of Radiation Oncology, National Taiwan University Hospital;
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MD, PhD, Professor, Department of Colorectal Surgery, Taipei Veteran General Hospital;
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MD, Department of Radiation Oncology, Taipei Veteran General Hospital;
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MD, Director, Department of Colorectal Surgery, Taichung Veteran General Hospital;
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MD, Professor, Director, Department of General Surgery, Tri- Service General Hospital;
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MD, Associate Professor, Director, Department of Radiology, Tri- Service General Hospital;
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MD, Director, Department of Oncology, Taipei Mackay Memorial Hospital;
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MD, PhD, Associate Professor, Director, Department of Oncology, Far Eastern Memorial Hospital;
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MD, Director, Department of Internal Medicine, Taipei Cathy General Hospital;
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MD, Director, Department of Pathology, Taipei Cathy General Hospital;
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MD, PhD, Department of oncology, Chung-Gung Memorial Hospital;
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MD, PhD, Professor, Director, Department of Colorectal Surgery, Chung-Gung Memorial Hospital;
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MD, PhD, Professor, Director, Department of Medicine, Chung-Gung Memorial Hospital;
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MD, PhD, Associate Professor, Director, Department of Oncology, Chung-Gung Memorial Hospital;
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MD, PhD, Professor, Director, Department of Surgery, National Chen-Gung University Hospital;
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MD, PhD, Professor, Director, Department of Pathology, National Chen-Gung University Hospital;
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MD, Director, Department of Internal Medicine, Kaohsiung Medical University Hospital;
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MD, PhD, Director, Department of Oncology, Chung-Gung Memorial Hospital.
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National Taiwan University Hospital;
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National Chen-Gung University Hospital;
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Taipei Veteran General Hospital;
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Taichung Veteran General Hospital;
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Kaohsiung Veteran General Hospital;
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Taipei Mackay Memorial Hospital;
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Tri- Service General Hospital;
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Koo Foundation Sun Yet-Sen Cancer Center;
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Buddhist Tzu Chi General Hospital, Da-Lin Branch;
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Taipei Cathy General Hospital;
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Shin Kong Wu Ho-Su Memorial Hospital;
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Chung-Gung Memorial Hospital;
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Chung-Gung Memorial Hospital, Kaohsiung Branch;
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China Medical University Hospital, Taiwan;
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Changhua Christian Hospital;
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Chia-Yi Christian Hospital;
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Chi Mei Medical Center;
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Kaohsiung Medical University Hospital.