Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics

BMC Cancer

Research Article

Nicole M.A. Blijlevens¹  Petronella B. Ottevanger²  Johan H.J.M. van Krieken³  Helena M. Dekker⁴  Richard W.M. van der Maazen⁵  Saskia A.M. van de Schans⁶  Lianne Wennekes⁷  Rosella P.M.G. Hermens⁷  Jozette J.C. Stienen⁷  Janine Liefers⁷ 

[1] Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands;Department of Medical Oncology, Radboud university medical center, Nijmegen, the Netherlands;Department of Pathology, Radboud university medical center, Nijmegen, the Netherlands;Department of Radiology, Radboud university medical center, Nijmegen, the Netherlands;Department of Radiotherapy, Radboud university medical center, Nijmegen, the Netherlands;Netherlands Comprehensive Cancer Organisation, Department of Registry and Research, PO box 19079, 3501 DB, Utrecht, the Netherlands;Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center (Radboud umc), PO Box 9101, 6500 HB, Nijmegen, the Netherlands;

关键词: Non-Hodgkin’s lymphoma;    Hematology;    Guidelines;    Determinants;    Hospital variation;    Oncology;   

DOI  :  10.1186/s12885-015-1547-8

 received in 2014-11-05, accepted in 2015-07-14,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Stienen et al. 2015