Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroesophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy.

Study Design: Retrospective cohort study. Objective: There is only limited data on the outcome of primary surgery of lumbar disk herniation (LDH) in Dutch patients. The objective of this study is to describe undesirable outcomes after primary LDH. Methods: The National Claims Database (Vektis) was searched for primary LDH operations performed from July 2015 until June 2016, for reoperations within 18 months, prescription of opioids between 6 to 12 months and nerve root block within 1 year. A combined outcome measure was also made. Group comparisons were analyzed with the Student’s t-test. Results: Primary LDH surgery was performed in 6895 patients in 70 hospitals. Weighted mean of reoperations was 7.3%, nerve root block 6.7% and opioid use 15.6%. In total, 23.0% of patients had one or more undesirable outcomes after surgery. The 95% CI interval exceeded the 50% incidence line for 14 out of 26 hospitals with less than 50 surgical interventions per year. Although the data suggested a volume effect on undesired outcomes, the t-tests between hospitals with volume thresholds of 100, 150 and 200 interventions per year did not support this ( P values 0.078, 0.129, 0.114). Conclusion: This unique nationwide claims-based study provides insight into patient-relevant undesirable outcomes such as reoperation, nerve root block and opioid use after LDH surgery. About a quarter of the patients had a serious complication in the first follow up year that prompted further medical treatment. There is a wide variation in complication rates between hospitals with a trend that supports concentration of LDH care.

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Background Previous quality assessments in oncology focused on surgical issues such as number of annual operations per hospital. However, high-quality of care depends on an excellent interplay between all disciplines involved in cancer care. The NABON (National Breast Cancer Organisation of the Netherlands) has, therefore, developed a multidisciplinary set of 30 quality indicators to check and improve breast cancer care. Health insurers have recently decided to use this information for purchasing. Methods The NABON Breast Cancer Audit (NBCA) started in 2011. Data on all newly diagnosed patients with invasive breast cancer in the Netherlands are collected by the Netherlands Cancer Registry (n=61 hospitals) or by the physicians themselves (n=31 hospitals). Data capture is facilitated using a web-based portal and feedback to participating hospitals on their own data is being done every week. Since 2012 all Dutch hospitals participate. A set of quality indicators on process and outcome was selected following established clinical guidelines and is being supervised by a multidisciplinary steering committee. Results Data of all 41,958 breast cancer patients treated between 2011 and 2013 were collected. In 2013, 94% of patients were discussed in the multidisciplinary team prior to first treatment and 98% after surgery. BI-RADS score was used in 98% of radiological reports. After neo-adjuvant chemotherapy, 7.6% of patients had positive specimen margins following first breast conserving surgery compared to 5.0% and 20% of patients following primary breast conserving surgery for invasive cancer and ductal carcinoma in situ, respectively. Eighteen percent and 36% of patients underwent immediate breast reconstruction after mastectomy for invasive cancer and ductal carcinoma in situ, respectively. Pathological analysis showed 12% of patients had HER2 positive and 85% had ER positive disease. Neo-adjuvant or adjuvant systemic therapy was given to 63% of patients and neo-adjuvant or adjuvant chemotherapy to 39% of patients. Time between diagnosis and first treatment was generally short: 49% to 85% underwent primary surgery with and without immediate reconstruction, respectively, and 76% underwent neo-adjuvant chemotherapy within 5 weeks from first biopsy. At the conference we will show that variation between hospitals was not related to annual surgical volume per hospital. Conclusion The NBCA is a unique national system to provide and confirm quality assessment in breast cancer and to drive improvements in quality of multidisciplinary breast cancer care. Present results show an overall high quality of care in the Netherlands and provide insight in items of improvement. Citation Format: Vivianne C Tjan-Heijnen, Annelotte C van Bommel, Margriet van der Heiden-van der Loo, Pieter Westenend, Bart de Vries, Carolien H Smorenburg, Agnes Jager, Marc B Lobbes, Ruud M Pijnappel, John H Maduro, Henk Struikmans, Marc A Mureau, Marga Schrieks, Carol Richel, Maike Schepens, Thijs van Dalen, Michel W Wouters, Marie-Jeanne T Vrancken Peeters, Emiel J Rutgers, Sabine Siesling. Multidisciplinary breast cancer care registry and quality control system in the Netherlands: The NABON breast cancer audit [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-11-03.

Background Reuse of health care data for various purposes, such as the care process, for quality measurement, research, and finance, will become increasingly important in the future; therefore, “Collect Once Use Many Times” (COUMT). Clinical information models (CIMs) can be used for content standardization. Data collection for national quality registries (NQRs) often requires manual data entry or batch processing. Preferably, NQRs collect required data by extracting data recorded during the health care process and stored in the electronic health record. Objectives The first objective of this study was to analyze the level of coverage of data elements in NQRs with developed Dutch CIMs (DCIMs). The second objective was to analyze the most predominant DCIMs, both in terms of the coverage of data elements as well as in their prevalence across existing NQRs. Methods For the first objective, a mapping method was used which consisted of six steps, ranging from a description of the clinical pathway to a detailed mapping of data elements. For the second objective, the total number of data elements that matched with a specific DCIM was counted and divided by the total number of evaluated data elements. Results An average of 83.0% (standard deviation: 11.8%) of data elements in studied NQRs could be mapped to existing DCIMs . In total, 5 out of 100 DCIMs were needed to map 48.6% of the data elements. Conclusion This study substantiates the potential of using existing DCIMs for data collection in Dutch NQRs and gives direction to further implementation of DCIMs. The developed method is applicable to other domains. For NQRs, implementation should start with the five DCIMs that are most prevalently used in the NQRs. Furthermore, a national agreement on the leading principle of COUMT for the use and implementation for DCIMs and (inter)national code lists is needed.

Background The lifetime risk of developing breast cancer is 1 in 8 for women in the Netherlands. Breast cancer care in the Netherlands is of high quality, resulting in low 5-year local recurrence rates of 1.5% after breast conserving therapy and 2.7% after mastectomy. Although good endpoints of breast cancer treatment are obtained, it is expected that further improvement of care can be achieved since unexplained variation in a number of treatment aspects was found between hospitals in the Netherlands. Clinical audits provide an important tool for quality assessment. Worldwide, only a few nationwide clinical audits for breast cancer care are currently running. In the Netherlands, a nationwide multidisciplinary clinical audit started three years ago. Material and methods The multidisciplinary national NABON Breast Cancer Audit (NBCA) started collecting data of all Dutch hospitals in 2011, facilitated by Comprehensive Cancer Centre the Netherlands (IKNL) and Dutch Institute for Clinical Auditing (DICA). The NBCA has several purposes: nation-wide evaluation of quality parameters, evaluation of guideline adherence, and providing weekly updated feedback to participating institutions. Results All Dutch hospitals (n=92) participate by providing data regarding delivered breast cancer care resulting in a database of more than 42.000 breast cancer patients (5.745 DCIS and 36.396 invasive carcinomas) in three years time. Eighty-nine percent of invasive breast cancer patients were treated with primary surgery of which 62% (n=19.885) with breast conserving surgery. Within three years time, several quality assessments improved such as guideline compliance for pre- and postoperative multidisciplinary team meetings, percentage of patients starting surgery within five weeks (see table). The percentage of patients that were treated with preoperative systemic treatment (12%; 95% CI: 0 – 47%) and patients receiving an immediate reconstruction after ablative surgery (19%; 95% CI 0 – 73%) still remained low with a large variation between hospitals. At the conference, results will be substantiated by funnelplots. Other quality indicators will be presented as well. Table 1. Quality indicator results and their improvement over years.20112013Preoperative MDT81%96%Postoperative MDT90%98%Time to operation ≤5 weeks (immediate reconstruction after mastectomy excluded)80%85%Tumor positive margins invasive breast cancer (without PST)6.1%5.0%Tumor positive margins DCIS25%20%PST for invasive breast cancer10%12%Immediate reconstruction after ablative surgery for invasive breast cancer15%19%Immediate reconstruction after ablative surgery for DCIS39%44%MDT= Multi-disciplinary team meeting; PST= Primary Systemic Treatment; DCIS= Ductal Carcinoma In Situ Conclusions The continuous cycle of registration and providing feedback by clinical auditing provides a powerful tool for quality monitoring and improving breast cancer care. Improvements of monodisciplinairy surgical and pathological aspects of care have been reached in a relatively short time period. However, for more complicated multidisciplinary issues like the use of primary systemic treatment and immediate reconstruction, detailed analyses of the variation between hospitals is needed to further improve these aspects of breast cancer care. Citation Format: Annelotte C van Bommel, Marie-Jeanne T Baas-Vrancken Peeters, Margriet van der Heiden - van der Loo, Thijs van Dalen, Emiel J Rutgers, Michel W Wouters, Marc B Lobbes, Ruud M Pijnappel, Marc A Mureau, Pieter J Westenend, Bart de Vries, Carolien H Smorenburg, Agnes Jager, John H Maduro, Henk Struikmans, Carol Richel, Marga Schrieks, Maike Schepens, Sabine Siesling, Vivianne C Tjan-Heijnen. The NABON breast cancer audit; quality improvement in three years' time [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-18.