Assurance de qualité pour le cancer rectal - phase 3
Authors: Goetghebeur Els , Van Rossem Ronan , Baert Katrien , Vanhoutte Kurt , Boterberg Tom , Demetter Pieter , De Ridder Mark , Harrington David , Peeters Marc , Storme Guy , Verhulst Johanna , Vlayen Joan , Vrijens France , Vansteedlandt Stijn , Ceelen Wim 
Published: January 2025

LIST OF TABLES 3 -- LIST OF FIGURES 5 -- LIST OF ABBREVIATIONS 6 -- ABBREVIATED LIST OF AVAILABLE QCIS 7 -- 1 INTRODUCTION AND RESEARCH QUESTIONS 9 -- 1.1 BACKGROUND 9 -- 1.2 THE CURRENT PROJECT 9 -- 2 CONCEPTUAL FRAMEWORK AND METHODOLOGICAL APPROACH FOR -- THE ESTIMATION AND BENCH MARKING OF CENTER EFFECTS ON -- QUALITY INDEXES 11 -- 2.1 PATIENT MIX ADJUSTMENT FOR QUALITY OF CARE INDICATORS. 11 -- 2.1.1 The causal inference framework for center effects 11 -- 2.1.2 A motivated choice among different modeling approaches 12 -- 2.1.3 Limitations due to restricted variable access 13 -- 2.1.4 On the Instrumental Variables method 14 -- 2.1.5 Outcome regression methods and propensity score methods 15 -- 2.1.6 Scope of analysis 18 -- 2.2 LITERATURE SEARCH FOR PROGNOSTIC FACTORS OF RECTAL CANCER 20 -- 2.2.1 Methodological approach 20 -- 2.2.2 Results 20 -- 2.2.3 Discussion 21 -- 2.3 DIMENSIONS OF CARE AND THEIR AGGREGATION 22 -- 2.3.1 Goal 22 -- 2.3.2 Key approach 23 -- 2.3.3 Criteria for indexes 24 -- 2.3.4 Other issues in the construction of quality indicators and quality indexes 31 -- 2.4 REVIEW OF STATISTICAL METHODS FOR PROVIDER PROFILING 33 -- 2.4.1 Goals 33 -- 2.4.2 Methods for provider profiling in the literature 33 -- 2.4.3 Visualizing variation between centers 35 -- 2.4.4 Graphical presentation of center results 37 -- 2.5 PROPOSED APPROACH FOR PROCARE 40 -- 2.5.1 Choice of index 40 -- 2.5.2 Adjusting for patient specific factors 40 -- 2.5.3 Bench marking 40 -- 2.5.4 Visualization 40 -- 3 APPLICATION AND RESULTS ON THE PROCARE DATABASE 42 -- 3.1 INTRODUCTION 42 -- 3.2 METHODS 44 -- 3.2.1 Descriptive statistics 44 -- 3.2.2 Identification of relevant prognostic factors 45 -- 3.2.3 Estimation of unadjusted and case mix adjusted center effects 46 -- 3.3 DESCRIPTION OF THE STUDY COHORT 47 -- 3.3.1 Centers 47 -- 3.3.2 Prognostic factors 49 -- 3.3.3 Associations between prognostic factors 55 -- 3.3.4 Joint missingness patterns of prognostic factors 58 -- 3.3.5 Follow-up information 58 -- 3.4 DESCRIPTION AND ANALYSIS OF INDIVIDUAL QUALITY OF CARE INDICATORS 60 -- 3.4.1 The worked out case of Overall Survival QCI 1111 60 -- 3.4.2 Tabulated results for the QCIs 69 -- 3.5 SUMMARY POINTS 76 -- 4 AGGREGATED QUALITY INDEXES 78 -- 4.1 INTRODUCTION 78 -- 4.2 METHODS 78 -- 4.2.1 Evaluation of quality and reliability of the QCIs 78 -- 4.2.2 Number of dimensions needed 78 -- 4.2.3 Clinical importance and discriminating ability of selected QCIs per dimension 78 -- 4.2.4 Construction of the Quality Index 78 -- 4.2.5 Risk adjustment 79 -- 4.3 AN AGGREGATED OUTCOME QUALITY INDEX 79 -- 4.3.1 Quality and reliability of the QCIs 79 -- 4.3.2 Concurrent validity of the selected QCIs 79 -- 4.3.3 Clinical importance and discriminating ability of the selected QCIs per dimension 79 -- 4.3.4 Constructing the quality index (QI) 80 -- 4.3.5 Adjusting the outcome QI for patient characteristics 82 -- 4.4 AN AGGREGATED PROCESS QUALITY INDEX 85 -- 4.4.1 Quality and reliability of the QCIs 85 -- 4.4.2 Concurrent validity of selected QCIs 85 -- 4.4.3 Clinical importance and discriminating ability of selected QCIs per dimension 85 -- 4.4.4 Construction of the quality index (QI) 85 -- 4.5 AGGREGATED QUALITY INDEXES PER DOMAIN 90 -- 4.5.1 Overview of results 90 -- 4.5.2 Overview of variation per domain 98 -- 4.6 AN OVERALL COMPOSITE QUALITY INDEX 98 -- 5 MODEL BUILDING TO EXPLAIN EXCESS PROBABILITIES 101 -- 5.1 INTRODUCTION 101 -- 5.2 METHODOLOGY: FORWARD STEPWISE REGRESSION 101 -- 5.3 EXPLANATORY DESCRIPTIVES FOR EXTREME CENTER PERFORMANCE 102 -- 5.4 FORWARD STEPWISE REGRESSION 106 -- 6 DISCUSSION 108 -- 7 BIBLIOGRAPHY 112