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

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30 PROCARE – phase 2 KCE reports 81Table 17. Measurability of selected general QI.QI Prospective Db Administrative DbMeasurable? If not: reason? Measurable? If not: reason?1111 Not yet Follow-up too short Yes -1112 No No code No No code1113 Yes - No No code1114 No No code Yes -3.2.2.2 Quality indicators related to diagnosis and stagingProportion of patients with a documented distance from the analvergeDEFINITIONNumerator: all RC patients that underwent resection for rectal cancer (endoscopic,LE/TEMS, radical resection) and who have a documented distance from the anal verge.Denominator: all patients with RC that underwent resection (endoscopic, LE/TEMS,radical resection) for rectal cancer.Exclusion:• patients that didn’t undergo resectionRESULTSMore than 97% of patients with rectal cancer undergoing resectional surgery have adocumented distance from the anal verge (Table 18). No missing data were identified. Apotential problem with the measurement of this QI is that the distance from the analverge is registered in the PROCARE database on 3 occasions (pre-treatment data, intraoperativedata and pathology report; see appendix). This may lead to inconsistencieswhich may need interpretation by a clinician.Figure 7 provides an overview of the documented distance from the anal verge perparticipating centre using the prospective database. Forty-six of the 56 centres have ascore of 100%. Forty-seven centres have a score above the weighted (97%; 95%CI 96 –98%) and unweighted mean (97%; 95%CI 95 – 100%).The QI is not measurable for the administrative cohort, since no administrative codeexists for the (documentation of the) distance from the anal verge.Table 18. Number of patients with a documented distance from the analverge, measured with prospective PROCARE data.NPatients with rectal cancer 1071Patients with rectal cancer that underwent surgery 1058Patients with rectal cancer that underwent resectional surgery (local or 1018radical) (denominator)Patients with documented distance to anal verge (numerator) 990 (97%)
KCE Reports 81 PROCARE – phase 2 31Figure 7. Per-centre-analysis (n = 56) of documented distance from the analverge (prospective cohort) $ .100100909080807070Proportion (%)6050403060504030Number of patients (N)2020101000$ The weighted mean is presented with a red bar, the unweighted mean is presented with a bluehorizontal line. The grey bars represent the QI value per centre, while the blue dots representthe number of patients per centre. These results are preliminary, and cannot be used to judge thequality of care.Proportion of patients in whom a CT of the liver and RX or CTthorax was performed before any treatmentDEFINITIONNumerator: all patients with RC that underwent CT liver and RX or CT thorax beforethe first treatment.Denominator: all patients with RC that underwent treatment.Exclusion:• patients that didn’t receive treatmentRESULTSBecause no specific variable for CT liver, CT thorax or thorax X-ray is available in thePROCARE database, this QI is not measurable for the PROCARE cohort.In the administrative database, more specific codes are available (nomenclature codesfor thorax X-ray, ICD-9-CM codes for CT thorax and abdomen; see appendix).However, important limitations also render this QI incalculable and not interpretablefor the administrative cohort:• ICD-9-CM coding of CT thorax and abdomen is not obligatory for theMCD database. Above this, ambulatory tests are only available throughthe IMA database (nomenclature codes). Therefore, using ICD-9-CMcodes to track CT thorax and liver causes an important underestimation(Table 19).
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