Quality indicators for the management of head and neck squamous cell carcinoma

313 p.ill.,TABLE OF CONTENTS.1 -- LIST OF FIGURES 5 -- LIST OF TABLES.8 -- LIST OF ABBREVIATIONS .19 --  SCIENTIFIC REPORT 22 -- 1 INTRODUCTION.22 -- 1.1 HEAD AND NECK CANCER IN BELGIUM22 -- 1.2 DISPERSION OF CARE IN BELGIUM 23 -- 1.3 MEASURING QUALITY 24 -- 2 OBJECTIVES, SCOPE & TERMINOLOGY .25 -- 2.1 WHAT THIS STUDY AIMS AT AND DOES NOT AIM AT .25 -- 2.2 PRECEDING STEPS 26 -- 2.3 SCOPE.26 -- 2.4 TARGET AUDIENCE 26 -- 2.5 TERMINOLOGY 26 -- 3 METHODOLOGY27 -- 3.1 STEP 1: IDENTIFICATION OF THE TARGET POPULATION: DATA SELECTION AND LINKAGE OF DATABASES.27 -- 3.1.1 Selection of the study population in the Belgian Cancer Registry database .27 -- 3.1.2 Linkage with health insurance data.29 -- 3.1.3 Linkage with hospital discharge data.30 -- 3.1.4 Vital status30 -- 3.2 STEP 2: IDENTIFICATION AND SELECTION OF POSSIBLE QUALITY INDICATORS .30 -- 3.2.1 Identification of possible quality indicators 30 -- 3.2.2 Selection process and results 31 -- 3.2.3 Measurability of selected quality indicators 32 -- 3.2.4 Final selection of quality indicators to be fully elaborated32 -- 3.3 STEP 3: OPERATIONALIZATION OF INDICATORS 34 -- 3.3.1 Technical fiches 34 -- 3.3.2 Defining diagnostic and therapeutic procedures based on health insurance data.34 -- 3.3.3 Defining the treatment scheme of the patient 38 -- 3.3.4 Statistical analyses 38 -- 3.3.5 Case-mix adjustment .41 -- 3.4 STEP 4: ASSIGNMENT OF EACH PATIENT TO ONE CENTRE.45 -- 3.5 STEP 5: VALIDATION OF DIAGNOSTIC AND THERAPEUTIC DATA .46 -- 3.5.1 Introduction and methodology 46 -- 3.5.2 Validation of the algorithm to assign patients to one treatment hospital .47 -- 3.5.3 Validation of patient and tumour characteristics and of diagnostic and therapeutic procedures as identified in the health insurance data linked to cancer registry data .48 -- 3.6 STEP 6: MEASUREMENT OF QUALITY INDICATORS, AT NATIONAL LEVEL AND BY CENTRE.50 -- 3.7 STEP 7: INTERPRETATION OF RESULTS.50 -- 4 CHARACTERISTICS OF THE STUDY SAMPLE .50 -- 4.1 BASELINE DEMOGRAPHICS AND TUMOUR CHARACTERISTICS 50 -- 4.1.1 Patient characteristics 50 -- 4.1.2 Tumour characteristics 51 -- 4.2 MAIN DIAGNOSTIC AND STAGING PROCEDURES.52 -- 4.3 MAIN THERAPEUTIC PROCEDURES 53 -- 4.4 TIME TRENDS FOR MAIN DIAGNOSTIC, STAGING AND THERAPEUTIC PROCEDURES 56 -- 5 INDICATOR RESULTS 56 -- 5.1 QUALITY OF DIAGNOSIS AND STAGING IN SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK.56 -- 5.1.1 Timeliness of start of first treatment with curative intent (DS-1) 56 -- 5.1.2 MRI and/or contrast-enhanced CT of the primary site and draining lymph nodes before treatment (DS-2) 58 -- 5.1.3 T, N and M staging in new cases of SCC of the head and neck (DS-3) 60 -- 5.1.4 FDG-PET(/CT) before treatment (DS-4) 62 -- 5.2 QUALITY OF TREATMENT IN SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK 64 -- 5.2.1 Single modality treatment in stage I-II (T-1) 64 -- 5.2.2 Total laryngectomy in T4a laryngeal cancer (SX-1) 66 -- 5.2.3 Timeliness postoperative radiotherapy (RT-1) 67 -- 5.2.4 Primary chemoradiotherapy for locally-advanced non-metastatic disease (RT-2).69 -- 5.2.5 Neck imaging after primary (chemo)radiotherapy (LN-1) 71 -- 5.2.6 Elective neck dissection in cN0M0 squamous cell carcinoma of the head and neck (LN-2).72 -- 5.3 SAFETY OF CARE.74 -- 5.3.1 Post-treatment mortality (G-1) 74 -- 5.4 OBSERVED AND RELATIVE SURVIVAL .78 -- 5.4.1 The 1, 2 and 5-year observed and relative survival after a diagnosis of SCC of the head and neck (G-2) 78 -- 5.5 ASSOCIATION BETWEEN HOSPITAL VOLUME AND OUTCOME (V-1) 83 -- 5.5.1 Introduction .83 -- 5.5.2 Methods 83 -- 5.5.3 Results 84 -- 5.5.4 Discussion 89 -- 6 STRENGTHS AND LIMITATIONS 92 -- 7 CONCLUSIONS AND PERSPECTIVES FOR THE FUTURE.95 -- RECOMMENDATIONS 96 -- APPENDICES 99 -- APPENDIX 1. RARECARE DEFINITION HEAD AND NECK SQUAMOUS CELL CARCINOMA .99 -- APPENDIX 2. IDENTIFICATION AND SELECTION OF QUALITY INDICATORS 100 -- APPENDIX 3. BILLING CODES 115 -- APPENDIX 4. CASE MIX ADJUSTMENT 144 -- APPENDIX 5. VALIDATION 145 -- APPENDIX 6. DESCRIPTIVE DATA.164 -- APPENDIX 7. QUALITY INDICATORS 188 -- REFERENCES 30