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Abstract：
To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer.
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data.
Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.
Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (-$3,009 [-$5,226 to -$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals.
A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.
NA Laryngoscope, 130:672-678, 2020.
Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data.
Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.
Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (-$3,009 [-$5,226 to -$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals.
A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.
NA Laryngoscope, 130:672-678, 2020.
摘要：
使用观察到的预期（O/E）比率来检查生存率与对国家综合癌症网络（NCCN）治疗指南的依从性之间的关联，以提高依从性，作为接受喉癌治疗的老年患者的优质护理的风险调整医院措施。
监测的回顾性分析，流行病学,和最终结果(SEER)-医疗保险数据。
使用多元回归和生存分析对2004年至2007年诊断为喉癌的患者进行评估。使用拟合逻辑回归模型，使用从推荐治疗的NCCN指南得出的质量指标并按医院数量分层，计算每家医院的指南依从性的O/E比。
在395家医院接受治疗的1,721名患者中，43.0%的患者接受了NCCN指导依从护理。低容量医院（N=295）治疗6例或更少的病例治疗765例患者（44.5%），平均O/E为0.96±0.45。医院治疗超过6例O/E<1（N=32）治疗284例患者（16.5%），平均O/E为0.77±0.18。医院治疗超过6例O/E≥1（N=68）治疗672例患者（39.1%），平均O/E为1.17±0.11。与O/E<1的医院(HR=1.00[0.80至1.24])和低容量医院参照组相比,O/E≥1的医院的治疗与生存率改善(风险比[HR]=0.83[95%置信区间[CI]:0.70至0.98])和平均治疗相关费用增加(-$3,009[-$5,226至-$791])相关。
针对NCCN治疗指南依从性的医院特定O/E，结合最小案例体积标准，与老年喉癌患者的生存和治疗相关费用有关，并可能是衡量喉癌护理质量的可行指标。
NA喉镜，130:672-678，2020。
监测的回顾性分析，流行病学,和最终结果(SEER)-医疗保险数据。
使用多元回归和生存分析对2004年至2007年诊断为喉癌的患者进行评估。使用拟合逻辑回归模型，使用从推荐治疗的NCCN指南得出的质量指标并按医院数量分层，计算每家医院的指南依从性的O/E比。
在395家医院接受治疗的1,721名患者中，43.0%的患者接受了NCCN指导依从护理。低容量医院（N=295）治疗6例或更少的病例治疗765例患者（44.5%），平均O/E为0.96±0.45。医院治疗超过6例O/E<1（N=32）治疗284例患者（16.5%），平均O/E为0.77±0.18。医院治疗超过6例O/E≥1（N=68）治疗672例患者（39.1%），平均O/E为1.17±0.11。与O/E<1的医院(HR=1.00[0.80至1.24])和低容量医院参照组相比,O/E≥1的医院的治疗与生存率改善(风险比[HR]=0.83[95%置信区间[CI]:0.70至0.98])和平均治疗相关费用增加(-$3,009[-$5,226至-$791])相关。
针对NCCN治疗指南依从性的医院特定O/E，结合最小案例体积标准，与老年喉癌患者的生存和治疗相关费用有关，并可能是衡量喉癌护理质量的可行指标。
NA喉镜，130:672-678，2020。
