Leiden University Medical Centre, Dept of Surgery K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Eur J Surg Oncol. 2013 Feb;39(2):156-63. doi: 10.1016/j.ejso.2012.10.007. Epub 2012 Oct 25.
We propose a summarizing measure for outcome indicators, representing the proportion of patients for whom all desired short-term outcomes of care (a 'textbook outcome') is realized. The aim of this study was to investigate hospital variation in the proportion of patients with a 'textbook outcome' after colon cancer resections in the Netherlands.
Patients who underwent a colon cancer resection in 2010 in the Netherlands were included in the Dutch Surgical Colorectal Audit. A textbook outcome was defined as hospital survival, radical resection, no reintervention, no ostomy, no adverse outcome and a hospital stay < 14 days. We calculated the number of hospitals with a significantly higher (positive outlier) or lower (negative outlier) Observed/Expected (O/E) textbook outcome than average. As quality measures may be more discriminative in a low-risk population, analyses were repeated for low-risk patients only.
A total of 5582 patients, treated in 82 hospitals were included. Average textbook outcome was 49% (range 26-71%). Eight hospitals were identified as negative outliers. In these hospitals a 'textbook outcome' was realized in 35% vs. 52% in average hospitals (p < 0.01). In a sub-analysis for low-risk patients, only one additional negative outlier was identified.
The textbook outcome, representing the proportion of patients with a perfect hospitalization, gives a simple comprehensive summary of hospital performance, while preventing indicator driven practice. Therewith the 'textbook outcome' is meaningful for patients, providers, insurance companies and healthcare inspectorate.
我们提出了一种用于结局指标的总结衡量方法，代表所有期望的短期治疗结局（“理想结局”）都实现的患者比例。本研究旨在调查荷兰结肠癌手术后患者达到“理想结局”的医院差异。
荷兰外科结直肠审计纳入了 2010 年接受结肠癌切除术的患者。“理想结局”定义为医院生存率、根治性切除、无再次干预、无造口术、无不良结局和住院时间<14 天。我们计算了观察到的/预期的（O/E）理想结局明显高于（正离群值）或低于（负离群值）平均值的医院数量。由于质量指标在低风险人群中可能更具区分度，因此仅对低风险患者重复进行了分析。
共纳入了 5582 例患者，他们在 82 家医院接受治疗。平均理想结局为 49%（范围 26-71%）。有 8 家医院被确定为负离群值。在这些医院中，“理想结局”的实现比例为 35%，而平均医院为 52%（p<0.01）。在低风险患者的亚组分析中，仅发现了一个额外的负离群值。
“理想结局”代表了具有完美住院经历的患者比例，它全面综合地总结了医院的表现，同时防止了指标驱动的实践。因此，“理想结局”对患者、医疗服务提供者、保险公司和医疗监管机构都具有重要意义。
