Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome?

N.E. Kolfschoten, G.A. Gooiker, E. Bastiaannet, N.J. van Leersum, C.J.H. van de Velde, E.H. Eddes, P.J. Marang-van de Mheen, J. Kievit, E. van der Harst, T. Wiggers, M. Wouters, R. Tollenaar*, R. Dutch Surgical Colorectal Audit Group (incl. van Dam)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care. Design: Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hospitals. Setting: The Dutch Surgical Colorectal Audit database, the Netherlands. Participants: 4732 elective patients with colon carcinoma and 2239 with rectum carcinoma treated in 85 hospitals were included in the analyses. Main outcome measures: 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. Results: 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. Conclusions: 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.
Original languageEnglish
Pages (from-to)481-489
Number of pages9
JournalBMJ Quality & Safety
Issue number6
Publication statusPublished - Jun 2012



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