Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
BMJ Qual Saf. 2012 Jun;21(6):481-9. doi: 10.1136/bmjqs-2011-000439. Epub 2012 Apr 4.
To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care.
Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hospitals.
The Dutch Surgical Colorectal Audit database, the Netherlands.
4732 elective patients with colon carcinoma and 2239 with rectum carcinoma treated in 85 hospitals were included in the analyses.
All available process indicators were aggregated into five different composite measures. The association of the different composite measures with risk-adjusted postoperative mortality and morbidity was analysed at the patient and hospital level.
At the patient level, only one of the composite measures was negatively associated with morbidity for rectum carcinoma. At the hospital level, a strong negative association was found between composite measures and hospital mortality and morbidity rates for rectum carcinoma (p<0.05), and hospital morbidity rates for colon carcinoma.
For individual patients, a high score on the composite measures based on process indicators is not associated with better short-term outcome. However, at the hospital level, a good score on the composite measures based on process indicators was consistent with more favourable risk-adjusted short-term outcome rates.
确定基于过程指标的综合措施是否与结直肠癌外科治疗的短期结果指标一致。
对 85 家荷兰医院的过程指标和结果指标的综合措施之间一致性的纵向分析。
荷兰荷兰外科结直肠审计数据库。
4732 例结肠癌和 2239 例直肠癌的择期患者在 85 家医院接受治疗，纳入分析。
将所有可用的过程指标汇总成五种不同的综合措施。在患者和医院层面分析不同综合措施与风险调整后的术后死亡率和发病率的相关性。
在患者层面，只有一种综合措施与直肠癌的发病率呈负相关。在医院层面，综合措施与直肠癌的医院死亡率和发病率（p<0.05）以及结肠癌的医院发病率呈强烈的负相关。
对于个体患者，基于过程指标的综合措施评分高并不一定与更好的短期结果相关。然而，在医院层面，基于过程指标的综合措施评分良好与更有利的风险调整短期结果率一致。
