Quality of colorectal cancer care in Japan: A nationwide multicenter study.

Abstract

e16542 Background: Although colorectal cancer is the third leading cause of cancer death in Japan, the quality of care provided for colorectal cancer patients remains largely unknown. Reports of variation in quality from other countries have aroused patient concern. This study aimed to develop quality indicators for colorectal cancer and to shed light on the current status of quality of colorectal cancer care in Japan. Methods: First, we developed process-of-care quality indicators for colorectal cancer through the RAND/UCLA appropriateness methodology, which included preparation of candidate quality indicators, and two rounds of ratings by a panel of 11 multidisciplinary experts with face-to-face discussion between the ratings. Using medical record abstractions, we then applied these quality indicators to the care of colorectal cancer patients in 16 hospitals in 2007 nationwide. Quality scores were calculated as the percentage of patients who received care as described in the quality indicators. Results: The expert panel approved 45 quality indicators, which covered care from diagnostic evaluation, treatment, to follow-up surveillance and management of recurrent disease. In total, the medical records of 1803 patients were abstracted. For some quality indicators, performance was 100% for almost all hospitals (e.g., documentation of resection methods in endoscopic treatment:100% for 3/4 hospitals) while other quality indicators had scores of less than 10% for most hospitals, (e.g., Informed consent about the effectiveness, adverse events, and cost before chemotherapy: < 10% for 3/4 hospitals). Large variation was observed for some indicators (e.g., appropriate lymph node dissection for stage II/III colon cancer; inter-quartile range 39%- 71%). Conclusions: Using quality indicators covering various aspects of colorectal cancer care, our study revealed that quality of care has substantial room for improvement in Japan. Future research should explore effective interventions for improvement. No significant financial relationships to disclose.