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.
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。