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  • Measure Summary
  • NQMC:011168
  • Jan 2015

Upper gastrointestinal (GI) cancer: proportion of patients undergoing surgical resection for oesophageal or gastric cancer who are discharged within 21 days of surgical procedure.

NHS Scotland, Scottish Cancer Taskforce. Upper GI cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland, Scottish Government; 2015 Jan. 41 p. [15 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients undergoing surgical resection for oesophageal or gastric cancer who are discharged within 21 days of surgical procedure.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Evidence suggests that there is a relationship between increasing surgical volumes for oesophageal resection and improved patient outcomes (mortality) (NHS Quality Improvement Scotland, 2008); however, there is conflicting evidence to support an actual volume of procedures. Furthermore, the literature suggests that oesophageal and gastric resection should be performed by surgeons who work in a specialist multidisciplinary team (MDT) in a high volume hospital, with outcomes audited regularly and benchmarked nationally (Scottish Intercollegiate Guidelines Network [SIGN], 2006; Knight et al., 2011).

The Association of Upper Gastrointestinal Surgeons of Great Britain and Northern Ireland (AUGIS) recommend that a hospital carrying out oesophagogastric surgical resection should consist of 4 to 6 surgeons, undertaking a minimum of 15 resections per surgeon per year (NHS Quality Improvement Scotland, 2008). This recommendation is based on clinical evidence, taking into account the European Working Time Directive which details the staffing requirements for hospital units, training aspects and the requirement to have 24/7 access to specialist consultants.

Length of hospital stay acts as a surrogate measure for the quality of surgery and post-operative care for patients undergoing surgical resection for oesophagogastric cancer.

This Cancer Quality Performance Indicator (QPI) is intended as a surrogate marker to address various issues of quality care including surgery, post-operative complications and access to community services.

Evidence for Rationale

Knight G, Earle CC, Cosby R, Coburn N, Youssef Y, Spithoff K, Malthaner R, Wong RKS, Gastrointestinal Cancer Disease Site Group. Neoadjuvant or adjuvant therapy for resectable gastric cancer. Toronto (ON): Cancer Care Ontario (CCO); 2011 Apr 5. 70 p. (Evidence-based series; no. 2-14).  [147 references]

NHS Quality Improvement Scotland. Management of bowel cancer services. Edinburgh (Scotland): NHS Quality Improvement Scotland; 2008 Mar. 41 p. [36 references]

NHS Scotland, Scottish Cancer Taskforce. Upper GI cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland, Scottish Government; 2015 Jan. 41 p. [15 references]

Scottish Intercollegiate Guidelines Network (SIGN). Management of oesophageal and gastric cancer. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2006 Jun. 69 p. (SIGN publication; no. 87).  [393 references]

Primary Health Components

Oesophageal cancer; gastric cancer; surgical resection; length of stay

Denominator Description

All patients undergoing surgical resection for oesophageal or gastric cancer

Numerator Description

Number of patients undergoing surgical resection for oesophageal or gastric cancer who are discharged within 21 days of surgical procedure

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients undergoing surgical resection for oesophageal or gastric cancer

Exclusions
None

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of patients undergoing surgical resection for oesophageal or gastric cancer who are discharged within 21 days of surgical procedure

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Proxy for Outcome

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 60%

The tolerance within this target is designed to account for situations where it is not safe or practical for patients to go home within 21 days of surgery.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce. Upper GI cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland, Scottish Government; 2015 Jan. 41 p. [15 references]

Original Title

QPI 9 – length of hospital stay following surgery.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Upper GI Cancer

Measure Subset Name

Surgical Outcome QPIs

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Upper GI Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jan

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce. Upper GI cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland, Scottish Government; 2015 Jan. 41 p. [15 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 19, 2017.

Copyright Statement

No copyright restrictions apply.

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