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Sampurno F, Kowalski C, Connor SE, Nguyen AV, Acuña ÀP, Ng CF, Foster C, Feick G, Boronat OG, Dieng S, Brglevska S, Ferrante S, Leung S, Villanti P, Moore CM, Graham ID, Millar JL, Litwin MS, Papa N. Knowledge and insights from a maturing international clinical quality registry. J Am Med Inform Assoc 2022; 29:964-969. [PMID: 35048976 PMCID: PMC9006702 DOI: 10.1093/jamia/ocab281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 01/22/2023] Open
Abstract
Since 2017, the TrueNTH Global Registry (TNGR) has aimed to drive improvement in patient outcomes for individuals with localized prostate cancer by collating data from healthcare institutions across 13 countries. As TNGR matures, a systematic evaluation of existing processes and documents is necessary to evaluate whether the registry is operating as intended. The main supporting documents: protocol and data dictionary, were comprehensively reviewed in a series of meetings over a 10-month period by an international working group. In parallel, individual consultations with local institutions regarding a benchmarking quality-of-care report were conducted. Four consensus areas for improvement emerged: updating operational definitions, appraisal of the recruitment process, refinement of data elements, and improvement of data quality and reporting. Recommendations presented were drawn from our collective experience and accumulated knowledge in operating an international registry. These can be readily generalized to other health-related reporting programs beyond clinical registries.
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Affiliation(s)
- Fanny Sampurno
- Corresponding Author: Fanny Sampurno, BA, BSc (Hons), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia;
| | | | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anissa V Nguyen
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Àngels Pont Acuña
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Chi-Fai Ng
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Günter Feick
- Patient Support Association Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | - Olatz Garin Boronat
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | | | - Stephanie Ferrante
- Department of Urology, University of Michigan (on behalf of MUSIC), Ann Arbor, Michigan, USA
| | - Steven Leung
- SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Caroline M Moore
- Department of Urology, Division of Surgical and Interventional Science, University College London, London, UK
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy L Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Maharaj AD, Holland JF, Scarborough RO, Evans SM, Ioannou LJ, Brown W, Croagh DG, Pilgrim CHC, Kench JG, Lipton LR, Leong T, McNeil JJ, Nikfarjam M, Aly A, Burton PR, Cashin PA, Chu J, Duong CP, Evans P, Goldstein D, Haydon A, Hii MW, Knowles BPF, Merrett ND, Michael M, Neale RE, Philip J, Porter IWT, Smith M, Spillane J, Tagkalidis PP, Zalcberg JR. The Upper Gastrointestinal Cancer Registry (UGICR): a clinical quality registry to monitor and improve care in upper gastrointestinal cancers. BMJ Open 2019; 9:e031434. [PMID: 31575580 PMCID: PMC6773358 DOI: 10.1136/bmjopen-2019-031434] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Upper Gastrointestinal Cancer Registry (UGICR) was developed to monitor and improve the quality of care provided to patients with upper gastrointestinal cancers in Australia. PARTICIPANTS It supports four cancer modules: pancreatic, oesophagogastric, biliary and primary liver cancer. The pancreatic cancer (PC) module was the first module to be implemented, with others being established in a staged approach. Individuals are recruited to the registry if they are aged 18 years or older, have received care for their cancer at a participating public/private hospital or private clinic in Australia and do not opt out of participation. FINDINGS TO DATE The UGICR is governed by a multidisciplinary steering committee that provides clinical governance and oversees clinical working parties. The role of the working parties is to develop quality indicators based on best practice for each registry module, develop the minimum datasets and provide guidance in analysing and reporting of results. Data are captured from existing data sources (population-based cancer incidence registries, pathology databases and hospital-coded data) and manually from clinical records. Data collectors directly enter information into a secure web-based Research Electronic Data Capture (REDCap) data collection platform. The PC module began with a pilot phase, and subsequently, we used a formal modified Delphi consensus process to establish a core set of quality indicators for PC. The second module developed was the oesophagogastric cancer (OGC) module. Results of the 1 year pilot phases for PC and OGC modules are included in this cohort profile. FUTURE PLANS The UGICR will provide regular reports of risk-adjusted, benchmarked performance on a range of quality indicators that will highlight variations in care and clinical outcomes at a health service level. The registry has also been developed with the view to collect patient-reported outcomes (PROs), which will further add to our understanding of the care of patients with these cancers.
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Affiliation(s)
- Ashika D Maharaj
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer F Holland
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ri O Scarborough
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Liane J Ioannou
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | | | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John J McNeil
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Austin Health, Melbourne, Victoria, Australia
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cuong P Duong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Evans
- Peninsula Health, Melbourne, Victoria, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, Prince of Wales, Randwick, New South Wales, Australia
| | | | - Michael W Hii
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Neil D Merrett
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rachel E Neale
- Population Health Division, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | - Marty Smith
- Alfred Health, Melbourne, Victoria, Australia
| | - John Spillane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - John R Zalcberg
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Maharaj AD, Ioannou L, Croagh D, Zalcberg J, Neale RE, Goldstein D, Merrett N, Kench JG, White K, Pilgrim CHC, Chantrill L, Cosman P, Kneebone A, Lipton L, Nikfarjam M, Philip J, Sandroussi C, Tagkalidis P, Chye R, Haghighi KS, Samra J, Evans SM. Monitoring quality of care for patients with pancreatic cancer: a modified Delphi consensus. HPB (Oxford) 2019; 21:444-455. [PMID: 30316625 DOI: 10.1016/j.hpb.2018.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/02/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Best practise care optimises survival and quality of life in patients with pancreatic cancer (PC), but there is evidence of variability in management and suboptimal care for some patients. Monitoring practise is necessary to underpin improvement initiatives. We aimed to develop a core set of quality indicators that measure quality of care across the disease trajectory. METHODS A modified, three-round Delphi survey was performed among experts with wide experience in PC care across three states in Australia. A total of 107 potential quality indicators were identified from the literature and divided into five areas: diagnosis and staging, surgery, other treatment, patient management and outcomes. A further six indicators were added by the panel, increasing potential quality indicators to 113. Rated on a scale of 1-9, indicators with high median importance and feasibility (score 7-9) and low disagreement (<1) were considered in the candidate set. RESULTS From 113 potential quality indicators, 34 indicators met the inclusion criteria and 27 (7 diagnosis and staging, 5 surgical, 4 other treatment, 5 patient management, 6 outcome) were included in the final set. CONCLUSIONS The developed indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research in PC care.
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Affiliation(s)
- Ashika D Maharaj
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Liane Ioannou
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Daniel Croagh
- Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia; Epworth Healthcare, Richmond, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, NSW, Australia
| | - Neil Merrett
- School of Medicine, Western Sydney University, NSW, Australia
| | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia
| | - Kate White
- Sydney Nursing School, University of Sydney, Australia
| | - Charles H C Pilgrim
- Alfred Health, Melbourne, Victoria, Australia; Cabrini, Malvern, Victoria, Australia; Peninsula Health, Frankston, Victoria, Australia; Peninsula Private Hospital, Frankston, Victoria, Australia
| | - Lorraine Chantrill
- Kinghorn Cancer Centre, St Vincent's Hospital, NSW, Australia; Garvan Institute of Medical Research and University of New South Wales, NSW, Australia
| | - Peter Cosman
- School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, Australia
| | | | - Lara Lipton
- Cabrini, Malvern, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia; Western Health, Sunshine, Victoria, Australia
| | - Mehrdad Nikfarjam
- Melbourne University, Parkville, Victoria, Australia; Austin Health, Heidelberg, Australia
| | | | | | - Peter Tagkalidis
- Alfred Health, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richard Chye
- St Vincent's Private Hospital, Darlinghurst, NSW, Australia; Faculty of Health, University of Technology, NSW, Australia
| | - Koroush S Haghighi
- Prince of Wales Clinical School, UNSW Medicine, NSW, Australia; Kinghorn Cancer Centre, St Vincent's Hospital, NSW, Australia
| | - Jaswinder Samra
- Department of Upper GI Surgery, Royal North Shore Hospital, NSW, Australia; Macquarie University Hospital, Macquarie University, Australia
| | - Sue M Evans
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
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Alexander M, Wolfe R, Ball D, Conron M, Stirling RG, Solomon B, MacManus M, Officer A, Karnam S, Burbury K, Evans SM. Lung cancer prognostic index: a risk score to predict overall survival after the diagnosis of non-small-cell lung cancer. Br J Cancer 2017; 117:744-751. [PMID: 28728168 PMCID: PMC5572183 DOI: 10.1038/bjc.2017.232] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Non-small-cell lung cancer outcomes are poor but heterogeneous, even within stage groups. To improve prognostic precision we aimed to develop and validate a simple prognostic model using patient and disease variables. METHODS Prospective registry and study data were analysed using Cox proportional hazards regression to derive a prognostic model (hospital 1, n=695), which was subsequently tested (Harrell's c-statistic for discrimination and Cox-Snell residuals for calibration) in two independent validation cohorts (hospital 2, n=479 and hospital 3, n=284). RESULTS The derived Lung Cancer Prognostic Index (LCPI) included stage, histology, mutation status, performance status, weight loss, smoking history, respiratory comorbidity, sex, and age. Two-year overall survival rates according to LCPI in the derivation and two validation cohorts, respectively, were 84, 77, and 68% (LCPI 1: score⩽9); 61, 61, and 42% (LCPI 2: score 10-13); 33, 32, and 14% (LCPI 3: score 14-16); 7, 16, and 5% (LCPI 4: score ⩾15). Discrimination (c-statistic) was 0.74 for the derivation cohort, 0.72 and 0.71 for the two validation cohorts. CONCLUSIONS The LCPI contributes additional prognostic information, which may be used to counsel patients, guide trial eligibility or design, or standardise mortality risk for epidemiological analyses.
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Affiliation(s)
- Marliese Alexander
- Department of Epidemiology and Preventive Medicine Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
- Pharmacy Department Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
| | - David Ball
- Department of Radiation Oncology Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Matthew Conron
- Department Respiratory and Sleep Medicine St Vincent’s Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Robert G Stirling
- Department of Allergy Immunology and Respiratory Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Medical Oncology Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Michael MacManus
- Department of Radiation Oncology Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ann Officer
- Departments of Radiation Oncology and Medical Oncology Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Sameer Karnam
- Department Respiratory and Sleep Medicine St Vincent’s Hospital, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
| | - Kate Burbury
- Department of Haematology Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
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