Abstract
BackgroundIt remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan.MethodsA web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014.ResultsAmong 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer “performed at the doctor’s discretion” showed a significant negative impact on prognosis, suggesting importance of institutional uniformity.ConclusionsThe medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.
Highlights
Yasushi Toh and Hiroyuki Yamamoto contributed to this work.Axior Mita 6F, Minato‐ku, Tokyo 108‐0073, JapanQuality of care is measured by “the degree to which health services for individuals and populations increase the likelihood of the desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine: http://www.nationalacademies.org/hmd/)
Three-hundred and eighty-nine (45.9%) out of 847 institutions certified by Japanese Society of Gastroenterological Surgery (JSGS) as of 2014 and 98 (86.7%) out of 113 institutions certified by Japan Esophageal Society (JES) as of 2014 responded to the questionnaire
We investigated the relationship of the medical care system in relation to esophageal surgery and the status of implementation of the selected Quality indicators (QIs) to the operative mortality in each department, through conducting a questionnaire survey of the departments registered in the National Clinical Database (NCD)
Summary
Yasushi Toh and Hiroyuki Yamamoto contributed to this work.Axior Mita 6F, Minato‐ku, Tokyo 108‐0073, JapanQuality of care is measured by “the degree to which health services for individuals and populations increase the likelihood of the desired health outcomes and are consistent with current professional knowledge” (Institute of Medicine: http://www.nationalacademies.org/hmd/). In the field of gastroenterological surgery, detailed data on 8 major surgical procedures have been collected to prepare a risk model for each surgical procedure, which is utilized as a risk calculator for risk evaluations in clinical settings [6,7,8,9,10,11,12,13] It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy
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