Benchmarking quality for renal cancer surgery: Canadian Kidney Cancer information system (CKCis) perspective

Authors

  • Keith A. Lawson Division of Urology, Princess Margaret Hospital, University of Toronto
  • Olli Saarela Dalla Lana School of Public Health, University of Toronto
  • Zhihui Liu Dalla Lana School of Public Health, University of Toronto
  • Luke T. Lavallée Division of Urology, University of Ottawa
  • Rodney H. Breau Division of Urology, University of Ottawa
  • Lori Wood Division of Medical Oncology, Dalhousie University
  • Michael A.S. Jewett Division of Urology, Princess Margaret Hospital, University of Toronto
  • Anil Kapoor Division of Urology, McMaster University
  • Simon Tanguay Division of Urology, McGill University
  • Ronald B. Moore Division of Urology, University of Alberta
  • Ricardo Rendon Department of Urology, Dalhousie University
  • Frederic Pouliot Division of Urology, Université Laval
  • Peter C. Black Department of Urologic Sciences, University of British Columbia
  • Jun Kawakami Division of Urology, University of Calgary
  • Darrel Drachenberg Division of Urology, University of Manitoba
  • Antonio Finelli Division of Urology, Princess Margaret Hospital, University of Toronto

DOI:

https://doi.org/10.5489/cuaj.4397

Abstract

Introduction: There is a lack of validated quality metrics to evaluate the care of patients receiving surgery for renal cell carcinoma (RCC). To address this, the Kidney Cancer Research Network of Canada defined a list of quality indicators (QI) to assess hospital-level performance. We have case-mix adjusted these QIs to benchmark RCC surgical care at Canadian academic centres.

Methods: The Canadian Kidney Cancer information system (CKCis) was used to measure six QIs: laparoscopic approach proportion (LA), partial nephrectomy proportion (PN), partial nephrectomy in patients with chronic kidney disease (CKDPN), positive margin rate (PMR), partial nephrectomy complication rate (PNCx), and warm ischemia time (WIT). To benchmark performance, indirect
standardization (observed-to-expected ratio) methodology was employed using multivariate regression models.

Results: Multivariate models for LA, PN, and CKDPN demonstrate good discrimination and were used for benchmarking. National averages of 74% (70‒78%), 73% (70‒75%), and 70% (67‒74%) for the LA, PN, and CKDPN QIs, respectively, were determined and used to benchmark individual hospital performance. Overall, three (23%), two (15%), and two (15%) hospitals performed below expected for LA, PN, and CKDPN, respectively. Hospital identity was an independent predictor of LA, PN, and CKDPN (p<0.001).

Conclusions: Significant variability between CKCis hospitals for three RCC surgical QIs exists. Using the CKCis infrastructure may provide a framework for institution-level audit feedback for quality improvement. Greater CKCis capture rates and further data supporting the construct validity of these QIs are required to extend the use of this dataset to real-world quality initiatives.

Downloads

Download data is not yet available.

Downloads

Published

2017-08-11

How to Cite

Lawson, K. A., Saarela, O., Liu, Z., Lavallée, L. T., Breau, R. H., Wood, L., Jewett, M. A., Kapoor, A., Tanguay, S., Moore, R. B., Rendon, R., Pouliot, F., Black, P. C., Kawakami, J., Drachenberg, D., & Finelli, A. (2017). Benchmarking quality for renal cancer surgery: Canadian Kidney Cancer information system (CKCis) perspective. Canadian Urological Association Journal, 11(8), 232–7. https://doi.org/10.5489/cuaj.4397

Issue

Vol. 11 No. 8 (2017): CUAJ August

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.