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Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome?
  1. N E Kolfschoten1,
  2. G A Gooiker1,
  3. E Bastiaannet1,
  4. N J van Leersum1,
  5. C J H van de Velde1,
  6. E H Eddes2,
  7. P J Marang-van de Mheen3,
  8. J Kievit1,3,
  9. E van der Harst4,
  10. T Wiggers5,
  11. M W J M Wouters6,
  12. R A E M Tollenaar1,
  13. On behalf of the Dutch Surgical Colorectal Audit group*
  1. 1Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Department of Surgery, Deventer Hospital, Deventer, The Netherlands
  3. 3Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Surgery, Maasstadziekenhuis, Rotterdam, The Netherlands
  5. 5Department of Surgery, Groningen University Hospital, Groningen, The Netherlands
  6. 6Department of Surgery, Dutch Cancer Institute, Amsterdam, The Netherlands
  1. Correspondence to Professor Dr R A E M Tollenaar, Department of Surgery, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands; r.a.e.m.tollenaar{at}


Objective To determine if composite measures based on process indicators are consistent with short-term outcome indicators in surgical colorectal cancer care.

Design Longitudinal analysis of consistency between composite measures based on process indicators and outcome indicators for 85 Dutch hospitals.

Setting The Dutch Surgical Colorectal Audit database, the Netherlands.

Participants 4732 elective patients with colon carcinoma and 2239 with rectum carcinoma treated in 85 hospitals were included in the analyses.

Main outcome measures All available process indicators were aggregated into five different composite measures. The association of the different composite measures with risk-adjusted postoperative mortality and morbidity was analysed at the patient and hospital level.

Results At the patient level, only one of the composite measures was negatively associated with morbidity for rectum carcinoma. At the hospital level, a strong negative association was found between composite measures and hospital mortality and morbidity rates for rectum carcinoma (p<0.05), and hospital morbidity rates for colon carcinoma.

Conclusions For individual patients, a high score on the composite measures based on process indicators is not associated with better short-term outcome. However, at the hospital level, a good score on the composite measures based on process indicators was consistent with more favourable risk-adjusted short-term outcome rates.

  • Performance measures
  • quality measurement
  • adverse events
  • epidemiology and detection
  • surgery
  • comparative effectiveness research
  • decision making
  • patient satisfaction

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  • Data access: All authors had full access to all data.

  • * Members of Dutch Surgical Colorectal Audit group: W A Bemelman, O R C Busch, R M van Dam, M L E A Jansen-Landheer, Th M Karsten, J H J M van Krieken, W G T Kuijpers, V E Lemmens, E R Manusama, W J H J Meijerink, H J T Rutten.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available. The dataset is available via