Abstract
BackgroundThe present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data.MethodsThe cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000–2007).Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients.ResultsAmong rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload.A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status.ConclusionsThe study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.
Highlights
The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care
Study population The study cohort of incident colorectal cancer cases in the resident population of the Piedmont Region was identified from the Piedmont Hospital Discharge Record (HDR) system over an 8-year period using a validated algorithm [26] based on combinations of diagnostic and surgical procedure codes according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
The probability to undergoing RT was reduced in females versus males, and, as expected, for patients with comorbidity (Charlson index ≥1 odds ratios (OR) 0.73, 95%95% confidence interval (CI) 0.59-0.90) or metastases (0.47, 95% confidence intervals (95%CI) 0.35-0.65)
Summary
The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. Administrative data provide information on quality of care, and monitor indicators of care that can be used for assessment at a population- and hospital-level [8,9]. Clinical data available in administrative databases are considered limited in accuracy [11], their validity should be assessed, as variations exist between countries and periods, and between variables included. The use of administrative data in the assessment of quality of care among colorectal cancer patients is common in the United States [12,13], Canada [14] and Northern Europe (United Kingdom, Sweden and Denmark) [6,7,15].
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