Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals
Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutc...
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| Veröffentlicht in: | PloS one 2021-12, Vol.16 (12), p.e0260870-e0260870 |
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| description | Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors.
Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores.
Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = |
| doi_str_mv | 10.1371/journal.pone.0260870 |
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Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores.
Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001).
This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0260870</identifier><identifier>PMID: 34919552</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged patients ; Aged, 80 and over ; Bias ; Biology and Life Sciences ; Cancer ; Cancer surgery ; Cancer therapies ; Care and treatment ; Colorectal cancer ; Colorectal carcinoma ; Colorectal Neoplasms - therapy ; Consortia ; Delivery of Health Care ; Efficiency ; Female ; Frailty ; Geriatrics ; Hospital Administration ; Hospitals ; Humans ; Linear programming ; Male ; Mathematical analysis ; Medical care ; Medical personnel ; Medicine ; Medicine and Health Sciences ; Mortality ; Netherlands ; Older people ; Patients ; People and Places ; Perioperative care ; Physical therapists ; Postoperative period ; Practice Patterns, Physicians ; Preoperative Care ; Quality management ; Surgery ; Variables ; Variation</subject><ispartof>PloS one, 2021-12, Vol.16 (12), p.e0260870-e0260870</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Heil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Heil et al 2021 Heil et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-45b5717ddfd1a75f40a0fb36372e75435c86ce280704d9d090589048447852773</citedby><cites>FETCH-LOGICAL-c692t-45b5717ddfd1a75f40a0fb36372e75435c86ce280704d9d090589048447852773</cites><orcidid>0000-0002-7058-2013</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682881/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8682881/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23868,27926,27927,53793,53795</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34919552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>El-Hussuna, Alaa</contributor><creatorcontrib>Heil, Thea C</creatorcontrib><creatorcontrib>Melis, René J F</creatorcontrib><creatorcontrib>Maas, Huub A A M</creatorcontrib><creatorcontrib>van Munster, Barbara C</creatorcontrib><creatorcontrib>Olde Rikkert, Marcel G M</creatorcontrib><creatorcontrib>de Wilt, Johannes H W</creatorcontrib><creatorcontrib>Adang, Eddy M M</creatorcontrib><creatorcontrib>PRECOLO consortium</creatorcontrib><creatorcontrib>on behalf of the PRECOLO consortium</creatorcontrib><title>Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors.
Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores.
Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001).
This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.</description><subject>Aged</subject><subject>Aged patients</subject><subject>Aged, 80 and over</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Cancer</subject><subject>Cancer surgery</subject><subject>Cancer therapies</subject><subject>Care and treatment</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>Colorectal Neoplasms - therapy</subject><subject>Consortia</subject><subject>Delivery of Health Care</subject><subject>Efficiency</subject><subject>Female</subject><subject>Frailty</subject><subject>Geriatrics</subject><subject>Hospital Administration</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Linear programming</subject><subject>Male</subject><subject>Mathematical analysis</subject><subject>Medical care</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Netherlands</subject><subject>Older people</subject><subject>Patients</subject><subject>People and Places</subject><subject>Perioperative care</subject><subject>Physical therapists</subject><subject>Postoperative period</subject><subject>Practice Patterns, Physicians</subject><subject>Preoperative Care</subject><subject>Quality 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efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals</title><author>Heil, Thea C ; Melis, René J F ; Maas, Huub A A M ; van Munster, Barbara C ; Olde Rikkert, Marcel G M ; de Wilt, Johannes H W ; Adang, Eddy M M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-45b5717ddfd1a75f40a0fb36372e75435c86ce280704d9d090589048447852773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged patients</topic><topic>Aged, 80 and over</topic><topic>Bias</topic><topic>Biology and Life Sciences</topic><topic>Cancer</topic><topic>Cancer surgery</topic><topic>Cancer therapies</topic><topic>Care and treatment</topic><topic>Colorectal cancer</topic><topic>Colorectal carcinoma</topic><topic>Colorectal Neoplasms - therapy</topic><topic>Consortia</topic><topic>Delivery of Health 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one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heil, Thea C</au><au>Melis, René J F</au><au>Maas, Huub A A M</au><au>van Munster, Barbara C</au><au>Olde Rikkert, Marcel G M</au><au>de Wilt, Johannes H W</au><au>Adang, Eddy M M</au><au>El-Hussuna, Alaa</au><aucorp>PRECOLO consortium</aucorp><aucorp>on behalf of the PRECOLO consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-12-17</date><risdate>2021</risdate><volume>16</volume><issue>12</issue><spage>e0260870</spage><epage>e0260870</epage><pages>e0260870-e0260870</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors.
Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians' judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores.
Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001).
This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34919552</pmid><doi>10.1371/journal.pone.0260870</doi><tpages>e0260870</tpages><orcidid>https://orcid.org/0000-0002-7058-2013</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-12, Vol.16 (12), p.e0260870-e0260870 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2611125989 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged patients Aged, 80 and over Bias Biology and Life Sciences Cancer Cancer surgery Cancer therapies Care and treatment Colorectal cancer Colorectal carcinoma Colorectal Neoplasms - therapy Consortia Delivery of Health Care Efficiency Female Frailty Geriatrics Hospital Administration Hospitals Humans Linear programming Male Mathematical analysis Medical care Medical personnel Medicine Medicine and Health Sciences Mortality Netherlands Older people Patients People and Places Perioperative care Physical therapists Postoperative period Practice Patterns, Physicians Preoperative Care Quality management Surgery Variables Variation |
| title | Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T11%3A10%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Technical%20efficiency%20evaluation%20of%20colorectal%20cancer%20care%20for%20older%20patients%20in%20Dutch%20hospitals&rft.jtitle=PloS%20one&rft.au=Heil,%20Thea%20C&rft.aucorp=PRECOLO%20consortium&rft.date=2021-12-17&rft.volume=16&rft.issue=12&rft.spage=e0260870&rft.epage=e0260870&rft.pages=e0260870-e0260870&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0260870&rft_dat=%3Cgale_plos_%3EA687220136%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2611125989&rft_id=info:pmid/34919552&rft_galeid=A687220136&rft_doaj_id=oai_doaj_org_article_b1c11a76c2f44337a8e2710fa1748e6d&rfr_iscdi=true |