Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data?A retrospective cohort study

Abstract

ObjectiveTo develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation.Study designRetrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome.Setting62 Dutch hospitals.Participants45 848 unique gastrointestinal patients discharged in 2015.Main outcome measureA broad range of clinical outcomes including length of stay, reintervention, readmission and doctor–patient counselling.ResultsPatients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%.ConclusionThis study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients.

Textbook Outcome

“…The multidimensional parameter TO is a relatively new concept which was found useful in other fields of surgery. [13][14][15]17,18 Our definition of TO was established by an international survey, conducted among experts in quality improvement in (pancreatic) surgery. Out of 17 items, absence of 6 complications was considered to reflect the ideal outcome after pancreatic surgery.…”

“…16 Nevertheless, previous studies in other surgical fields demonstrated that TO was a feasible and useful parameter for comparison of quality between institutions, also showing correlation with improved long-term outcomes after cancer surgery. [13][14][15]17,18 This study proposes a TO definition for pancreatic surgery, based on the opinion of international experts, and assesses predictors and associations with TO in a nationwide surgical audit.…”

Comparing textbook outcomes among patients undergoing surgery for cancer at U. S. News & World Report ranked hospitals

“…Van Roessel et al 38 noted that TO can better reflect the quality and may be a powerful parameter to assess quality between different hospitals during regular audits for pancreatic surgery. Similarly, several other investigators reported TO as a useful tool to assess interhospital variations among patients undergoing complex surgery 10,11,37 . As the TO composite measure combines important quality parameters into a single metric, TO may increase the reliability to evaluate overall hospital performance.…”

“…In addition, parameters with a low event rate, such as mortality, maybe due to chance and focus on such metrics may not provide reproducible and accurate information into actual variation around quality measures among different hospitals. In turn, several investigators have proposed composite outcomes measures as being more reliable to assess healthcare quality rather than focusing on individual outcome parameters 10–12 . Textbook outcome (TO) is one such composite measure that has gained increased adoption as a means to provide more comprehensive information about hospital performance.…”

Defining a textbook surgical outcome for patients undergoing surgical resection of intermediate and high‐grade soft tissue sarcomas of the extremities

“…To date, there are no uniformly accepted metrics to assess and benchmark surgical outcomes among hospitals and surgeons for STS of the extremities 15,16 . Emerging literature supports the concept of textbook outcomes (TOs) as one novel metric to reflect multiple domains of oncologic patient care, especially in patients undergoing complex surgical procedures 17‐20 . Conceptually, TOs are a composite of postoperative outcomes that define the optimal “textbook” hospitalization, primarily including variables, such as perioperative mortality, early postoperative morbidity, readmissions, as well as oncologic‐specific variables, such as margin status and lymph node retrieval that can reflect the quality of the surgical treatment.…”