Abstract
BackgroundThe objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care.MethodsValidated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data.ResultsData of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain.Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner.ConclusionFifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.
Highlights
The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care
Tumor related characteristics showed that 61 % had extranodal involvement, 60 % was diagnosed with an aggressive tumor and Ann Arbor stage III of IV was observed in 68 % of the patients
Three factors were excluded from further analyses: performance status and International Prognostic Index (IPI) score because of too many missing values and patient preferences because of
Summary
The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care. In the United States, NHL is the sixth most common cancer with an estimated number of almost 70,000 new cases in 2013 [2]. This heterogeneous group of malignant proliferations of Treatment of NHL is highly dependent on the type and stage of the tumor. More effective therapy options are emerging, partly due to many randomized controlled trials in this field. Despite these improvements, the fiveyear relative survival rate is still rather low for DLBCL
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