P14.31 Between hospital variation in timings to multidisciplinary glioblastoma care in the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii44-ii44
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
Multidisciplinary Treatment ◽  
Case Mix ◽  
National Guidelines ◽  
Tumor Registry ◽  
Hospital Variation ◽  
Long Time ◽  
Newly Diagnosed Glioblastoma ◽  
Brain Tumor Diagnosis

Abstract BACKGROUND Delay in cancer care may adversely affect emotional distress, treatment outcome and survival. Optimal timings in multidisciplinary glioblastoma care are a matter of debate and clear national guidelines only exist for time to neurosurgery. We evaluated the between-hospital variation in timings to neurosurgery and adjuvant radiotherapy and chemotherapy in newly diagnosed glioblastoma patients in the Netherlands. MATERIAL AND METHODS Data were obtained from the nation-wide Dutch Brain Tumor Registry between 2014 and 2018. All adult patients with glioblastoma were included, covering all 18 neurosurgical hospitals, 28 radiotherapy hospitals, and 33 oncology hospitals. Long time-to-surgery (TTS) was defined as >3 weeks from the date of first brain tumor diagnosis to surgery, long time-to-radiotherapy (TTR) as either >4 or >6 weeks after surgery, and long time-to-chemotherapy (TTC) as either >4 or >6 weeks after completion of radiotherapy. Between-hospital variation in standardized rate of long timings was analyzed in funnel plots after case-mix correction. RESULTS A total of 4203 patients were included. Median TTS was 20 days and 52.4% of patients underwent surgery within 3 weeks. Median TTR was 20 days and 24.6% of patients started radiotherapy within 4 weeks and 84.2% within 6 weeks after surgery. Median TTC was 28 days and 62.6% of patients received chemotherapy within 4 weeks and 91.8% within 6 weeks after radiotherapy. After case-mix correction, three (16.7%) neurosurgical hospitals had significantly more patients with longer than expected TTS. Three (10.7%) and one (3.6%) radiotherapy hospitals had significantly more patients with longer than expected TTR for >4 and >6 weeks, respectively. In seven (21.2%) chemotherapy hospitals, significantly less patients with TTC >4 weeks were observed than expected. In four (12.1%) chemotherapy hospitals, significantly more patients with TTC >4 weeks were observed than expected. CONCLUSION Between-hospital variation in timings to multidisciplinary treatment was observed in glioblastoma care in the Netherlands. A substantial percentage of patients experienced timings longer than anticipated.

scholarly journals Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

2020 ◽  
Vol 37 (6) ◽  
pp. 488-494
Author(s):  
Carmen S.S. Latenstein ◽  
Sarah Z. Wennmacker ◽  
Stef Groenewoud ◽  
Mark W. Noordenbos ◽  
Femke Atsma ◽  
...  
Keyword(s):  
The Netherlands ◽  
Clinical Outcomes ◽  
Gallstone Disease ◽  
Practice Variation ◽  
Emergency Department Visits ◽  
Case Mix ◽  
Hospital Variation ◽  
Improved Outcomes ◽  
Related Group ◽  
Nationwide Observational Study

<b><i>Background:</i></b> Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. <b><i>Methods:</i></b> A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013–2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in case-mix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. <b><i>Results:</i></b> In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013–2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5–1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. <b><i>Conclusion:</i></b> Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by &#x3c;2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

scholarly journals Feasibility, Safety and Effects of a One-Week, Ski-Based Exercise Intervention in Brain Tumor Patients and Their Relatives: A Pilot Study

2020 ◽  
Vol 9 (4) ◽  
pp. 1006
Author(s):  
Fabian M. Troschel ◽  
Christian Ramroth ◽  
Lars Lemcke ◽  
Jens Clasing ◽  
Amelie S. Troschel ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Adverse Events ◽  
Exercise Intervention ◽  
Multidisciplinary Treatment ◽  
Strong Increase ◽  
Tumor Patients ◽  
Psychological Burden ◽  
Rehabilitation Programs ◽  
Brain Tumor Diagnosis

A brain tumor diagnosis poses a significant psychological burden and it severely impacts quality of life (QOL), both in patients and relatives. However, comprehensive strategies addressing QOL in this setting remain rare. Here, we aim to share our findings of a one-week ski exercise intervention, with emphasis on feasibility, safety, QOL, and physical exercise. The intervention consisted of week-long daily ski sessions with professional ski guides as well as dedicated physicians present. The participants were handed questionnaires, including distress and QOL items before, during, and after the intervention. Using fitness watches, exercise intensity was also tracked at these timepoints. During the intervention, patients were checked for adverse events daily. Fifteen participants, nine patients after multidisciplinary treatment, and six relatives were included in the study. Additionally, 13 children participated in the exercise, but not in the study. All of the participants completed the entire program. No severe adverse events were documented during daily checks. There was a strong increase in quantified activity and QOL with a corresponding decrease in distress during the intervention, and, partly, afterwards. This prospective brain tumor rehabilitation study demonstrates the feasibility and safety of challenging ski exercise in brain tumor patients. The findings also underline the exercise-mediated QOL benefits, emphasizing the need for more comprehensive brain tumor rehabilitation programs.

261 LENGTH OF HOSPITAL STAY AND THE ASSOCIATION WITH READMISSION AFTER UNCOMPLICATED ESOPHAGECTOMY. SIGNIFICANT HOSPITAL VARIATION IN THE NETHERLANDS.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Voeten ◽  
L Werf ◽  
J Sandick ◽  
R Hillegersberg ◽  
M Berge Henegouwen
Keyword(s):  
Esophageal Cancer ◽  
The Netherlands ◽  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Short Length ◽  
Case Mix ◽  
Readmission Rates ◽  
Admission Rates ◽  
Hospital Variation

Abstract   Prolonged length of hospital stay is a negative outcome of esophageal cancer surgery, not only for the patient; it also leads to increased hospital costs. Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay and to investigate its association with readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients after an uncomplicated esophagectomy. Methods All patients registered in the Dutch Upper GI Cancer Audit (DUCA) who underwent a potentially curative esophageal cancer resection between 2015 and 2018 were considered for inclusion. Patients were excluded if they had an intraoperative and/or postoperative complication, if they were retransferred to the intensive care unit, or if they had undergone a re-intervention. Length of hospital stay was dichotomized around the national median into “short admissions” and “long admissions”. Hospital variation was evaluated using a case-mix corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with readmission rates was investigated using the χ2-statistic. Results A total of 1,007 patients was included for analyses. National median length of hospital stay was 9 days, ranging from 6.5–12.5 days among 17 hospitals. The percentage of “short admissions” per hospital ranged from 7.7% to 93.5%. After correction for case-mix variables, 2 hospitals had significantly higher “short admission” rates and 4 hospitals had significantly lower “short admission” rates (figure 1). Overall, 6.2% (hospital variation [0.0%–13.2%]) of patients was readmitted. Hospital readmission rates were not significantly different between hospitals with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusion Based on these nationwide audit data, length of hospital stay after an uncomplicated esophagectomy varied significantly between hospitals and ranged from 6.5 to 12.5 days among Dutch hospitals. Short length of hospital stay was not associated with a higher readmission rate. The hospital variation indicates that enhanced recovery programs are not implemented at the same level of efficacy among hospitals in the Netherlands. Nationwide improvement might lead to a substantial reduction of hospital costs.

scholarly journals Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen S. S. Latenstein ◽  
Floris M. Thunnissen ◽  
Mitchell Harker ◽  
Stef Groenewoud ◽  
Mark W. Noordenbos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
The Netherlands ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Clinical Outcomes ◽  
Emergency Department Visits ◽  
Case Mix ◽  
Hospital Variation ◽  
Operation Rate

Abstract Background Inguinal hernia repair has often been used as a showcase to illustrate practice variation in surgery. This study determined the degree of hospital variation in proportion of patients with an inguinal hernia undergoing operative repair and the effect of this variation on clinical outcomes. Methods A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands between 2013 and 2015. Patients with inguinal hernias were collected from the Diagnosis-Related-Group (DRG) database. The case-mix adjusted operation rate in patients with a new DRG determines the observed variation. Hospital variation in case-mix adjusted inguinal hernia repair-rates was calculated per year. Clinical outcomes after surgery were compared between hospitals with high and low adjusted operation-rates. Results In total, 95,637 patients were included. The overall operation rate was 71.6%. In 2013–2015, the case-mix adjusted performance of inguinal hernia repairs in hospitals with high rates was 1.6–1.9 times higher than in hospitals with low rates. Moreover, in hospitals with high adjusted rates of inguinal hernia repair the time to surgery was shorter, more laparoscopic procedures were performed, less emergency department visits were recorded post-operatively, while more emergency department visits were recorded when patients were treated conservatively compared to hospitals with low adjusted operation rates. Conclusion Hospital variation in inguinal hernia repair in the Netherlands is modest, operation-rates vary by less than two-fold, and variation is stable over time. Hernia repair in hospitals with high adjusted rates of inguinal hernia repair are associated with improved outcomes.

scholarly journals Hospital Variation in Cancer Treatments and Survival Outcomes of Advanced Melanoma Patients: Nationwide Quality Assurance in The Netherlands

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5077
Author(s):  
Jesper van Breeschoten ◽  
Alfonsus J.M. van den Eertwegh ◽  
Liesbeth C. de Wreede ◽  
Doranne L. Hilarius ◽  
Erik W. van Zwet ◽  
...  
Keyword(s):  
The Netherlands ◽  
Significant Variation ◽  
Empirical Bayes ◽  
Treatment Patterns ◽  
Case Mix ◽  
Survival Probabilities ◽  
Hospital Variation ◽  
Significant Difference ◽  
Melanoma Treatment ◽  
Systemic Therapies

Background: To assure a high quality of care for patients treated in Dutch melanoma centers, hospital variation in treatment patterns and outcomes is evaluated in the Dutch Melanoma Treatment Registry. The aim of this study was to assess center variation in treatments and 2-year survival probabilities of patients diagnosed between 2013 and 2017 in the Netherlands. Methods: We selected patients diagnosed between 2013 and 2017 with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry. Centers’ performance on 2-year survival was evaluated using Empirical Bayes estimates calculated in a random effects model. Treatment patterns of the centers with the lowest and highest estimates for 2-year survival were compared. Results: For patients diagnosed between 2014 and 2015, significant center variation in 2-year survival probabilities was observed even after correcting for case-mix and treatment with new systemic therapies. The different use of new systemic therapies partially explained the observed variation. From 2016 onwards, no significant difference in 2-year survival was observed between centers. Conclusion: Our data suggest that between 2014 and 2015, after correcting for patient case-mix, significant variation in 2-year survival probabilities between Dutch melanoma centers existed. The use of new systemic therapies could partially explain this variation. In 2013 and between 2016 and 2017, no significant variation between centers existed.

P14.40 Trends in distribution of glioblastoma care and patient’s travel distance; results from the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
High Volume ◽  
Travel Distance ◽  
Tumor Registry ◽  
Number Of Patients ◽  
Oncology Care ◽  
Time Periods ◽  
The Impact ◽  
Travel Distances

Abstract BACKGROUND Over the past years, increasing worldwide attention towards centralization of complex cancer care has been pursued as higher volume centers have shown improved outcomes. Changes in distribution of care and the impact on travel distance in glioblastoma patients have not been determined yet. In this study, we determine trends in distribution of glioblastoma care in the Netherlands over the last three decades and assess whether the observed trends affected travel distance for individual patients. MATERIAL AND METHODS Data were obtained from the Dutch Brain Tumor Registry from 1989 to 2018. All glioblastoma patients (≥18 years) were included for analysis. Patients, neurosurgical centers and radiotherapy centers were geocoded. Data were analyzed in six time intervals of 5 years. High volume hospitals were defined as &gt;50 cases per year. Travel distance was examined in two categories, ≤60km and &gt;60km respectively. Trend analyses for proportions were used to analyze hospital volume changes and travel distances. RESULTS A total of 16.477 glioblastoma patients were registered, with an annual increase from 203 patients in 1989 to 917 patients in 2018. Neurosurgical centers increased from 16 to 17 and for radiotherapy from 19 to 22 centers between 1989–1993 and 2014–2018. Mean neurosurgical- and radiotherapy center volumes increased from 12 to 39 (P=0.025) and 7 to 27 (P=0.025) patients per hospital per year from 1989–1993 to 2014–2018. High volume neurosurgical centers were observed since 2004, and an increased number of patients were treated in these centers, 27.8%, 52.6% and 64.1% in the time periods 2004–2008, 2009–2013, and 2014–2018 (P&lt;0.001). High volume radiology centers were observed since 2009, and 15.0% and 27.3% of patients were treated in these centers in the time periods 2009–2013 and 2014–2018 (P&lt;0.001). Patients with a travel distance &gt;60km to the neurosurgical center reduced from 15.8% to 13.2% (P=0.033). Travel distance &gt;60km to the radiotherapy center did not reduce significantly (10.4% to 8.8%, P=0.601). CONCLUSION An increasing number of glioblastoma patients were differentially treated in high volume neurosurgery and radiotherapy centers. The observation that this did not translate into increased travel distances, indicates accessible specialized Neuro-Oncology care for glioblastoma patients in The Netherlands.

scholarly journals The contribution of case mix, skill mix and care processes to the outcomes of community hospitals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Lenzi ◽  
K Y C Adja ◽  
D Pianori ◽  
C Reno ◽  
M P Fantini
Keyword(s):  
Older People ◽  
Unmet Needs ◽  
Working Hours ◽  
Case Mix ◽  
Community Hospitals ◽  
Organizational Models ◽  
Skill Mix ◽  
Processes Of Care ◽  
Hospital Variation ◽  
Care Processes

Abstract Background The rapid increase in the proportion of older people underscores the need for new organizational models to face the unmet needs of frail patients with multiple conditions. Community hospitals (CHs) could be a solution to tackle these needs and foster integration between acute and primary care. The aim of this study was to investigate which patients' characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver in this setting of care. Methods This study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, northern Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey; 3 non-respondent CHs were excluded. The study outcome was in-hospital variation of the Barthel index (BI) (≥10 vs. &lt;10). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level. Results Of the 13 CHs, 7 admitted ≥150 patients, 8 had a general practitioner medical support model, and 6 had &gt;12 nurses' working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10 (4% to 71% across CHs). The patient case mix (i.e. baseline BI, female, older age, transfer from acute care) explained a portion of variability across CHs, as shown by the VPC that decreased from 0.32 to 0.26. Skill mix and processes of care were not associated with BI change, and the VPC resulting from controlling for these variables was virtually unchanged (0.28). Conclusions Patients' characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes. Key messages A combination of quantitative and qualitative methods might better explain the outcome variability across intermediate care services. Multidisciplinary CH teams and services can be helpful to address the unmet needs of older people, but further studies are necessary.

scholarly journals Methicillin-Resistant Staphylococcus aureus Prevalence Among Healthcare Workers in Contact Tracings in a Dutch Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s316-s317
Author(s):  
Veronica Weterings ◽  
Heidi Kievits ◽  
Miranda van Rijen ◽  
Jan Kluytmans
Keyword(s):  
Staphylococcus Aureus ◽  
The Netherlands ◽  
Healthcare Workers ◽  
Index Case ◽  
Contact Tracing ◽  
Secondary Case ◽  
National Guidelines ◽  
Carriage Rate ◽  
Methicillin Resistant ◽  
Mlva Type

Background: In The Netherlands, the national guidelines on Methicillin-Resistant Staphylococcus aureus (MRSA) prevention and control advocate screening of healthcare workers (HCWs) after unprotected exposure to MRSA carriers. Although this strategy is largely successful, contact tracing of staff is a time-consuming and costly component. We evaluated our contact tracing policy for HCWs over the years 2010–2018. Methods: A retrospective, observational study was performed in a Dutch teaching hospital. All HCWs who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was an HCW, the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat, and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth. Molecular typing was performed using multiple-locus variable number of tandem repeat analysis (MLVA). Results: In total, we included 8,849 samples (range, 677–1,448 samples per year) from 287 contact tracings (range, 26–55 contact tracings per year). Overall, 32 HCWs were colonized with MRSA (0.36%; 95% CI, 0.26%–0.51%). None of them developed a clinical infection. Moreover, 8 HCWs (0.10%; 95% CI, 0.05%–0.19%) were colonized with the same MLVA type as the index case and were detected in 6 of 287 contact tracings (2%). In 4 of 8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3 of 8 cases, it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients. Notably, a different MLVA type as the index case was found in 24 HCWs (0.27%; 95% CI, 0.18%–0.40%) of whom 7 of 24 HCWs (29.2%) were intermittent carriers. Conclusions: This study revealed a sustained low MRSA prevalence among samples in contact tracing of HCWs over 9 years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline, only 1 of 1,000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise questions regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.Funding: NoneDisclosures: None

scholarly journals Construction of the National Brain Tumor Registry of China for better management and more efficient use of data: a protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040055
Author(s):  
Liwei Zhang ◽  
Wang Jia ◽  
Nan Ji ◽  
Deling Li ◽  
Dan Xiao ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Clinical Research ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Benefit Sharing ◽  
Data Quality Control ◽  
Clinical Trial Registry ◽  
Discharge Data ◽  
Tumor Registry ◽  
Depth Analysis

IntroductionBrain tumours encompass a complex group of intracranial tumours that mostly affect young adults and children, with a high incidence rate and poor prognosis. It remains impossible to systematically collect data on patients with brain tumours in China and difficult to perform in-depth analysis on the status of brain tumours, medical outcomes or other important medical issues through a multicentre clinical study. This study describes the first nation-wide data platform including the entire spectrum of brain tumour entities, which will allow better management and more efficient application of patient data in China.Methods and analysisThe National Brain Tumor Registry of China (NBTRC) is a registry of real-word clinical data on brain tumours. It is established and managed by the China National Clinical Research Center for Neurological Diseases and administered by its scientific and executive committees. The 54 participating hospitals of the NBTRC are located in 27 provinces/municipalities, performing more than 40 000 brain tumour surgeries per year. The data consist of in-hospital medical records, images and follow-up information after discharge. Data can be uploaded in three ways: the web portal, remote physical servers and offline software. The data quality control scheme is seven-dimensional. Each participating hospital could focus on a single pathology subtype and public subtypes of brain tumour for which they expect to conduct related multicentre clinical research. The standardised workflow to conduct clinical research is based on the benefit-sharing mechanism. Data collection will be conducted continuously from 1 February 2019 to 31 January 2024.Ethics and disseminationInformed consent will be obtained from all participants. Consent for the adolescents’ participation will be also obtained from their guardians via written consent. The results will be published in professional journals, in both Chinese and English.Trial registration numberChinese Clinical Trial Registry (ChiCTR1900021096).

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