Quality of gastric cancer care in designated cancer care hospitals in Japan

Impact of a board certification system and adherence to the clinical practice guidelines for gastric cancer on risk-adjusted surgical mortality after distal and total gastrectomy in Japan: a questionnaire survey of departments registered in the National Clinical Database

PURPOSE

The relationship between board certification, clinical guideline implementation, and quality of gastric cancer surgery remains unclear.

METHODS

A web-based questionnaire survey was administered to departments registered in the National Clinical Database (NCD) of Japan between October 2014 and January 2015. Quality indicators (QIs) based on the Donabedian model were evaluated. Structural QIs (e.g., affiliations with academic societies and board certifications) and process QIs (adherence to clinical practice guidelines for gastric cancer) were assessed using risk-adjusted odds ratios (AORs) for surgical mortality. Multivariable logistic regression models with a generalized estimating equation were used.

RESULTS

A total of 835 departments performing 40,992 distal gastrectomies and 806 departments performing 19,618 total gastrectomies responded. Some certified institutions and physicians showed significant associations, with lower AORs for surgical mortality. Important process QIs included pre- and postoperative abdominal CT scanning, endoscopic resection based on progression, curative resection with D2 dissection for advanced gastric cancer, laparoscopic surgery, and HER2 testing for patients with unresectable recurrent gastric cancer.

CONCLUSIONS

Multiple structural and process QIs are associated with surgical mortality after gastrectomy in Japan. Measuring and visualizing QIs may enhance healthcare improvements.

Global, Regional, and National Quality of Care Index (QCI) of Gastric Cancer: A Systematic Analysis for the Global Burden of Disease Study 1990-2017

BACKGROUND

Gastric Cancer (GC)is the third leading cause of cancer death worldwide. We aimed to compare the quality of care of GC at global, regional, and national levels from 1990 to 2017 in different age, sex, and socio-demographic groups using the quality-of-care index.

MATERIAL

METHOD: We used Mortality to Incidence Ratio, DALY to Prevalence Ratio, YLL to YLD Ratio, and Prevalence to Incidence Ratio, that all indicate the quality of care. Then, using Principal Component Analysis (PCA), these values are combined. A new index called QCI (Quality of Care Index), which indicates quality, is introduced to compare the quality of care in different countries in 1990 and 2017. Scores were calculated and scaled 0-100, with higher scores indicating better status.

RESULTS

The global QCI of GC in 1990 and 2017 was 35.7 and 66.7, respectively. The QCI index is 89.6 and 16.4 in high and low SDI countries, respectively. In 2017, Japan had the highest QCI with a 100 score. Japan was followed by South Korea, Singapore, Australia, and the United States with 99.5, 98.4, 98.3, and 90.0. On the other hand, the Central African Republic, Eritrea, Papua New Guinea, Lesotho, and Afghanistan with 11.6, 13.0, 13.1, 13.5, and 13.7 had the worst QCI, respectively.

CONCLUSION

The quality of care of GC has increased worldwide from 1990 to 2017. Also, higher SDI was associated with more quality of care. We recommend conducting more screening and therapeutic programs for early detection and to improve gastric cancer treatment in developing countries.

Quality performance indicator compliance for the treatment of gastric adenocarcinoma

BACKGROUND

Quality performance indicators (QPI) are objective measurements of aspects of patient care that affect clinical outcome. This study investigates the compliance rate to published QPIs of gastric adenocarcinoma (GA) management, in a single institution, to determine areas of strong performance and those requiring improvement.

METHODS

All patients with GA treated from 2010 to 2015, and 2020 to 2021 were included. Electronic data in the form of clinic letters, operation notes, and histology and radiology reports were reviewed with ethics approval. QPI adherence was collected in binary form.

RESULTS

QPIs with high compliance rate include preoperative radiological staging and histological diagnosis, subspecialty surgeon training and pathology report documentation. QPIs with low compliance include perioperative chemotherapy (31.6%), postoperative radiological surveillance (32.5%) and minimally invasive approaches to surgical resection (12.5%).

CONCLUSIONS

QPIs from the systematic review are variably implemented in clinical practice, thus informing on their relevance to real world clinical practice whilst also identifying the areas requiring focus for improvement.

Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review

Background

A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of gastric adenocarcinoma (GA) with the aim of defining a set of QPIs that can be used to assist in the accreditation of institutions for training, allow cross jurisdiction comparison of treatment and outcomes, as well as provide a basis to develop quality improvement programs. These QPI's capture key components of patient care that are fundamental to overall outcome.

Methods

A systematic literature review was conducted searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1 August 2021 included. Search terms utilized were ‘Quality of health care OR Quality improvement or Quality control OR Quality indicators’, AND ‘Gastrectomy’ OR ‘Stomach neoplasm’ OR ‘Adenocarcinoma’ OR ‘Gastric resection’ OR ‘Gastric cancer’.

Results

Twelve articles were included in the final analysis. The selected studies included editorials (n = 2), retrospective review of institutional experience (n = 5), cohort studies (n = 2), survey methodology (n = 1), expert guidelines (n = 1) and consensus statement (n = 1). For GC QPIs, process measures included patient discussion at multi‐disciplinary meetings, access to perioperative multimodal diagnostic pathways, and specific surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay.

Conclusions

There is a relative paucity of internationally agreed QPI for the surgical management of gastric adenocarcinoma. The data from this review will form the basis of a project to develop internationally agreed and feasible QPI for gastric cancer resections.

Development and Pilot Testing of Quality Indicators for Primary Care in Japan

Introduction:

To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan.

Methods:

Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, “Do you think it is preferable that the patients of this clinic be periodically surveyed?” and “Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?”

Results:

Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body.

Conclusions:

We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.

Quality of primary care provided in community clinics in Japan

BACKGROUND

Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan.

METHODS

Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic.

RESULTS

A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%.

CONCLUSIONS

The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.

Effect of operating room care combined with home care for the postoperative rehabilitation and prognosis of gastric cancer patients with low PTEN gene expression

The aim of the present study was to analyze the effect of operating room (OR) care combined with home care on postoperative rehabilitation and prognosis of gastric cancer patients with low PTEN gene expression. Ninety-six gastric cancer patients with low PTEN gene expression, who underwent surgical treatment in our hospital were recruited. PTEN expression was measured by semi-quantitative polymerase chain reaction. Participants were randomized into the observation and control groups, with 48 cases each. Participants in the two groups received the same preoperative examination, gastric cancer surgery, postoperative drug therapy, and general care, while observation group participants were provided more comprehensive OR care combined with home care. After 1 year of home care, the self-rating anxiety scale (SAS) and Hamilton anxiety scale (HAMA) scores, rehabilitation status, overall quality of life, and Family Adaptability and Cohesion Scale were applied to compare postoperative rehabilitation and prognosis status in both groups. Data were statistically analyzed. Patients were followed up for 3 years, and survival time was analyzed. The operative time and bleeding volume between the two groups were not significantly different (p>0.05). The time of extubation and postoperative recovery time in the observation group were shorter than in the control group (p<0.01). The postoperative SAS and HAMA scores in both groups were significantly decreased compared with those preoperatively (p<0.01). Additionally, these scores were significantly lower in the observation than in the control group (p<0.01). The rehabilitation status of body function in the observation group was better than in the control group (p<0.01). Regarding the overall quality of life score and family adaptability and cohesion score, the observation group was better than the control group (p<0.01). In conclusion, OR care combined with home care was effective for the care of gastric cancer patients with low PTEN expression. Improving patient mood and mental state played a positive role in postoperative rehabilitation and prognosis.

National Trends in Utilization of Endoscopic Ultrasound for Gastric Cancer: a SEER-Medicare Study

INTRODUCTION

Accurate preoperative staging is important for patients with gastric cancer. This study identifies the rate of utilization of endoscopic ultrasound (EUS) and its associated factors in Medicare patients with gastric adenocarcinoma.

METHODS

The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was queried from 1996 to 2009 for patients with gastric cancer who underwent gastric resection. Analysis with univariate, multivariate, and Cochran-Armitage trend tests were performed.

RESULTS

In 5826 patients with gastric cancer with an average age of 76.9 ± 6.62 years, 59.1% had regionalized spread of cancer. EUS utilization increased significantly during the study period from 2.6% to 22% (p < 0.0001). EUS patients were more likely to be male, white, married, have higher education and income quartiles, and live in large metropolitan areas compared to non-EUS patients (p < 0.0001). Even after controlling for confounding factors, patients who underwent EUS were more likely to have >15 lymph nodes examined (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.04-1.53) and have the administration of both pre- and postoperative chemotherapy (OR 1.27, 95% CI 1.03-1.57).

CONCLUSION

EUS is currently under-utilized but increasing. Patients who underwent EUS (12.9%) were more likely to receive other NCCN-recommended care, including perioperative chemotherapy and adequate nodal retrieval.

Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process

Background:

Despite increased cases published on breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), important clinical issues remain unanswered. We conducted a second structured expert consultation process to rate statements related to the diagnosis, management, and surveillance of this disease, based on their interpretation of published evidence.

Methods:

A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.

Results:

Panelists agreed that (1) this disease should be called “BIA-ALCL”; (2) late seromas occurring >1 year after breast implantation should be evaluated via ultrasound, and if a seroma is present, the fluid should be aspirated and sent for culture, cytology, flow cytometry, and cell block to an experienced hematopathologist; (3) surgical removal of the affected implant and capsule (as completely as possible) should occur, which is sufficient to eradicate capsule-confined BIA-ALCL; (4) surveillance should consist of clinical follow-up at least every 6 months for at least 5 years and breast ultrasound yearly for at least 2 years; and (5) BIA-ALCL is generally a biologically indolent disease with a good prognosis, unless it extends beyond the capsule and/or presents as a mass. They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.

Conclusions:

Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.