Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer

Warren C. Swegal; Robert J. Herbert; David W. Eisele; Jenny Chang; Robert E. Bristow; Christine G. Gourin

doi:10.1002/lary.28104

Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer

Warren C. Swegal, Robert J. Herbert, David W. Eisele, Jenny Chang, Robert E. Bristow, Christine G. Gourin

School of Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objectives/Hypothesis: To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer. Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Methods: Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume. Results: Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals. Conclusions: A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care. Level of Evidence: NA. Laryngoscope, 130:672–678, 2020.

Original language	English (US)
Pages (from-to)	672-678
Number of pages	7
Journal	Laryngoscope
Volume	130
Issue number	3
DOIs	https://doi.org/10.1002/lary.28104
State	Published - Mar 1 2020

Keywords

Epidemiology
Larynx neoplasms
Surveillance
and End Results-Medicare
chemotherapy
costs
elderly
guideline
larynx cancer
quality
radiation
squamous cell cancer
surgery
survival
treatment

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.28104

Cite this

@article{0918d46c9f6b4f93b01ff83987de35d9,

title = "Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer",

abstract = "Objectives/Hypothesis: To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer. Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Methods: Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume. Results: Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals. Conclusions: A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care. Level of Evidence: NA. Laryngoscope, 130:672–678, 2020.",

keywords = "Epidemiology, Larynx neoplasms, Surveillance, and End Results-Medicare, chemotherapy, costs, elderly, guideline, larynx cancer, quality, radiation, squamous cell cancer, surgery, survival, treatment",

author = "Swegal, {Warren C.} and Herbert, {Robert J.} and Eisele, {David W.} and Jenny Chang and Bristow, {Robert E.} and Gourin, {Christine G.}",

note = "Funding Information: This work was supported by an American Academy of Otolaryngology–Head and Neck Surgery Percy Memorial Research Award. Publisher Copyright: {\textcopyright} 2019 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2020",

month = mar,

day = "1",

doi = "10.1002/lary.28104",

language = "English (US)",

volume = "130",

pages = "672--678",

journal = "Laryngoscope",

issn = "0023-852X",

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TY - JOUR

T1 - Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer

AU - Swegal, Warren C.

AU - Herbert, Robert J.

AU - Eisele, David W.

AU - Chang, Jenny

AU - Bristow, Robert E.

AU - Gourin, Christine G.

N1 - Funding Information: This work was supported by an American Academy of Otolaryngology–Head and Neck Surgery Percy Memorial Research Award. Publisher Copyright: © 2019 The American Laryngological, Rhinological and Otological Society, Inc.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Objectives/Hypothesis: To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer. Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Methods: Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume. Results: Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals. Conclusions: A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care. Level of Evidence: NA. Laryngoscope, 130:672–678, 2020.

AB - Objectives/Hypothesis: To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed-to-expected (O/E) ratio for greater adherence as a risk-adjusted hospital measure of quality care in elderly patients treated for larynx cancer. Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Methods: Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume. Results: Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline-adherent care. Low-volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O/E of 0.96 ± 0.45. Hospitals treating more then six cases with an O/E <1 (N = 32) treated 284 patients (16.5%), with a mean O/E of 0.77 ± 0.18. Hospitals treating more than six cases with an O/E ≥1 (N = 68) treated 672 patients (39.1%), with a mean O/E of 1.17 ± 0.11. Treatment at hospitals with an O/E ≥1 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment-related costs (−$3,009 [−$5,226 to −$791]) compared with hospitals with an O/E <1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low-volume hospitals. Conclusions: A hospital-specific O/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment-related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care. Level of Evidence: NA. Laryngoscope, 130:672–678, 2020.

KW - Epidemiology

KW - Larynx neoplasms

KW - Surveillance

KW - and End Results-Medicare

KW - chemotherapy

KW - costs

KW - elderly

KW - guideline

KW - larynx cancer

KW - quality

KW - radiation

KW - squamous cell cancer

KW - surgery

KW - survival

KW - treatment

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M3 - Article

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SN - 0023-852X

VL - 130

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JO - Laryngoscope

JF - Laryngoscope

IS - 3

ER -

Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer

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