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Abstract：
OBJECTIVE: To develop an observed-to-expected ratio (O/E) for adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines as a risk-adjusted hospital measure of quality care correlated with disease-specific survival.
METHODS: Consecutive patients with stages I-IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96-12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume <5, middle two O/E quartiles and volume ≥5, and highest O/E quartile and volume ≥5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival.
RESULTS: Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n=285) treated 4661 patients (25.2%), mean O/E=0.77±0.55 and median survival 38.9months (95%CI=36.2-42.0months). Intermediate O/E hospitals (n=85) treated 8715 patients (47.1%), mean O/E=0.87±0.17 and median survival of 50.5months (95% CI=48.4-52.8months). Highest O/E hospitals (n=35) treated 5115 patients (27.7%), mean O/E=1.34±0.14 and median survival of 53.8months (95% CI=50.2-58.2months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR=1.06, 95% CI=1.01-1.11) and lowest O/E (1.16, 95% CI=1.10-1.23) hospitals.
CONCLUSIONS: Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival.
METHODS: Consecutive patients with stages I-IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96-12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume <5, middle two O/E quartiles and volume ≥5, and highest O/E quartile and volume ≥5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival.
RESULTS: Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n=285) treated 4661 patients (25.2%), mean O/E=0.77±0.55 and median survival 38.9months (95%CI=36.2-42.0months). Intermediate O/E hospitals (n=85) treated 8715 patients (47.1%), mean O/E=0.87±0.17 and median survival of 50.5months (95% CI=48.4-52.8months). Highest O/E hospitals (n=35) treated 5115 patients (27.7%), mean O/E=1.34±0.14 and median survival of 53.8months (95% CI=50.2-58.2months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR=1.06, 95% CI=1.01-1.11) and lowest O/E (1.16, 95% CI=1.10-1.23) hospitals.
CONCLUSIONS: Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival.
摘要：
目的：为遵守国家综合癌症网络（NCCN）卵巢癌治疗指南制定观察到的预期比率（O/E），作为与疾病特异性生存率相关的优质护理的风险调整后的医院衡量标准。
方法：从加利福尼亚癌症注册中心（1/1/96-12/31/06）确定I-IV期上皮性卵巢癌的连续患者。使用拟合逻辑回归模型，计算每个医院的指南依从性的O/E，并按医院年度病例量分层分配到四分位数：最低O/E四分位数或年度医院病例量<5，中间两个O/E四分位数和体积≥5，最高O/E四分位数和体积≥5。使用多变量逻辑回归模型来表征医院O/E对卵巢癌特异性生存的独立影响。
结果：总体而言，在405家医院接受了18,491例患者的治疗；37.3％接受了指南遵循护理。最低O/E医院（n=285）治疗了4661名患者（25.2％），平均O/E=0.77±0.55,中位生存期38.9个月(95CI=36.2-42.0个月).中级O/E医院（n=85）治疗了8715名患者（47.1％），平均O/E=0.87±0.17，中位生存期为50.5个月（95％CI=48.4-52.8个月）。最高的O/E医院（n=35）治疗了5115名患者（27.7%），平均O/E=1.34±0.14，中位生存期为53.8个月（95％CI=50.2-58.2个月）。在控制了其他变量之后，与中间O/E(HR=1.06,95%CI=1.01-1.11)和最低O/E(1.16,95%CI=1.10-1.23)医院相比,最高O/E医院的治疗与卵巢癌特异性生存率的独立且统计学显著改善相关.
结论：NCCN治疗指南依从性的医院特定O/E计算，结合最小案例体积标准，作为衡量卵巢癌的一项指标，护理质量是可行的，并且是生存率的独立预测因子。
方法：从加利福尼亚癌症注册中心（1/1/96-12/31/06）确定I-IV期上皮性卵巢癌的连续患者。使用拟合逻辑回归模型，计算每个医院的指南依从性的O/E，并按医院年度病例量分层分配到四分位数：最低O/E四分位数或年度医院病例量<5，中间两个O/E四分位数和体积≥5，最高O/E四分位数和体积≥5。使用多变量逻辑回归模型来表征医院O/E对卵巢癌特异性生存的独立影响。
结果：总体而言，在405家医院接受了18,491例患者的治疗；37.3％接受了指南遵循护理。最低O/E医院（n=285）治疗了4661名患者（25.2％），平均O/E=0.77±0.55,中位生存期38.9个月(95CI=36.2-42.0个月).中级O/E医院（n=85）治疗了8715名患者（47.1％），平均O/E=0.87±0.17，中位生存期为50.5个月（95％CI=48.4-52.8个月）。最高的O/E医院（n=35）治疗了5115名患者（27.7%），平均O/E=1.34±0.14，中位生存期为53.8个月（95％CI=50.2-58.2个月）。在控制了其他变量之后，与中间O/E(HR=1.06,95%CI=1.01-1.11)和最低O/E(1.16,95%CI=1.10-1.23)医院相比,最高O/E医院的治疗与卵巢癌特异性生存率的独立且统计学显著改善相关.
结论：NCCN治疗指南依从性的医院特定O/E计算，结合最小案例体积标准，作为衡量卵巢癌的一项指标，护理质量是可行的，并且是生存率的独立预测因子。
