Assurance de qualité pour le cancer rectal – phase 2 ...

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102 PROCARE – phase 2 KCE reports 81Figure 23. Algorithm for QI 1114 (administrative database).All patientsN = 7074N = 1473c-staging = IVor cN=1 or cN=2or cT=3 or cT=4 ?TrueIncidence datebetween 01.02.2003and 31.12.2003 ?FalseN = 183FalseN = 673TrueN = 5601MissingN = 617TrueMOCwithin 6 monthsafter incidence date ?N = 435FalseN = 238PROPORTION OF PATIENTS WITH DOCUMENTED DISTANCEFROM THE ANAL VERGEMeasurement in prospective PROCARE database (Figure 24)In the hospital data section of the PROCARE data entry form, the variable ‘AD_V111’ ischecked if the patient underwent rectal surgery. Within this group of patients, thoseundergoing resection (i.e. endoscopic, LE/TEMS, radical resection) are selected usingvariables ‘SG_V168’, ‘SG_V210’, ‘SG_V216’ and ‘SG_V234’. The distance from the analverge is available from 3 variables: two before any treatment (‘SPR_V110’ and‘SPR_V112’) and one at surgery (‘SG_V110’, which can have another value than theprevious two variables because of neoadjuvant treatment). A fourth variable is availablein the pathology section (‘PT_V105’), but this was not used because it is often based oninaccurate information. Importantly, unavailability of the distance from the anal verge inthe PROCARE dataset does not necessarily mean that the distance was notdocumented, but that the distance was not registered.Measurement in coupled administrative databaseNo administrative code exists for the (documentation of the) distance from the analverge.
KCE Reports 81 PROCARE – phase 2 103Figure 24. Algorithm for QI 1211 (PROCARE database).All patientsN=1071SurgeryN=1058RadicalsurgeryN=1018Documented distancefrom anal vergeN=990 97,1%Surgery?Radicalsurgery?Distance from analverge filled out?No radicalsurgeryORRadical surgery=MISSINGN=40No documented distancefrom anal vergeN=28No surgeryN=13PROPORTION OF PATIENTS IN WHOM A CT OF THE LIVER ANDCT OR RX OF THE THORAX WAS PERFORMED BEFORE ANYTREATMENTMeasurement in prospective PROCARE databaseVariables ‘SPR_V141’ and ‘SPR_V143’ register the use of a CT scan or RX respectivelyfor the determination of the cM stage. However, no specification is given for theanatomic region of the CT or RX. Therefore, this QI is not measurable.Measurement in coupled administrative database (Figure 25)A nomenclature code exists for the performance of a CT, however withoutspecification of the anatomic region (Table 62). On the other hand, specific ICD-9-CMcodes exist for CT of the abdomen (not liver!) and thorax (Table 63). However, thesecodes are only available from the Technical Cell database (see 3.1.2.2), which is adatabase of coupled hospital registration data (i.e. no information on ambulatoryperformance of these tests). Importantly, coding of these procedures is not obligatory.Therefore, using these codes causes an important underestimation of the frequency ofthese tests.In order to identify if the imaging test was done before any treatment, the date of thefirst treatment (surgery, radiotherapy, chemotherapy) after diagnosis should be known(see algorithm). To identify if and when a patient underwent surgery, nomenclaturecodes (Table 64 and 65) or surgical ICD-9-CM codes (Table 66, 67 and 68) incombination with diagnostic ICD-9-CM codes (Table 69) were used. For radiotherapy,nomenclature codes were used (Table 70), since for only 12 patients ICD-9-CM codesrelated to radiotherapy (Table 71) were found. For chemotherapy, the CNK codes ofthe HIC database were used (Table 72). An important problem with the Technical Celldatabase is the absence of the exact date of the procedure.
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