Head and Neck
Observed‐to‐expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer
Warren C. Swegal MD Robert J. Herbert BS David W. Eisele MD Jenny Chang MPH Robert E. Bristow MD Christine G. Gourin MD, MPH
First published: 06 June 2019 https://doi.org/10.1002/lary.28104
Editor's Note: This Manuscript was accepted for publication on May 20, 2019.
Presented at the 2019 Triological Society Combined Sections Meeting, Coronado, California, U.S.A., January 24–26, 2019.
This work was supported by an American Academy of Otolaryngology–Head and Neck Surgery Percy Memorial Research Award.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed‐to‐expected (O/E) ratio for greater adherence as a risk‐adjusted hospital measure of quality care in elderly patients treated for larynx cancer.
Study Design
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)‐Medicare data.
Methods
Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.
Results
Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline‐adherent care. Low‐volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment‐related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low‐volume hospitals.
Conclusions
A hospital‐specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment‐related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.
Level of Evidence
Observed‐to‐expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer
Warren C. Swegal MD Robert J. Herbert BS David W. Eisele MD Jenny Chang MPH Robert E. Bristow MD Christine G. Gourin MD, MPH
First published: 06 June 2019 https://doi.org/10.1002/lary.28104
Editor's Note: This Manuscript was accepted for publication on May 20, 2019.
Presented at the 2019 Triological Society Combined Sections Meeting, Coronado, California, U.S.A., January 24–26, 2019.
This work was supported by an American Academy of Otolaryngology–Head and Neck Surgery Percy Memorial Research Award.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Read the full text
ePDFPDFTOOLS SHARE
Abstract
Objectives/Hypothesis
To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed‐to‐expected (O/E) ratio for greater adherence as a risk‐adjusted hospital measure of quality care in elderly patients treated for larynx cancer.
Study Design
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)‐Medicare data.
Methods
Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.
Results
Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline‐adherent care. Low‐volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment‐related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low‐volume hospitals.
Conclusions
A hospital‐specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment‐related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.
Level of Evidence
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