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Dis Colon Rectum. 2009 Apr;52(4):616-22; discussion 622-3. doi: 10.1007/DCR.0b013e31819edb7d.

Evidence-based and clinical outcome scores to facilitate audit and feedback for colorectal cancer care.

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Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia.



To describe a methodology for surgical audit and feedback based on hospital-level indicators of the quality of colorectal cancer care.


Process and outcome indicators were identified from a population-based database (N = 3095 patients treated by 258 surgeons at 130 hospitals across New South Wales between February 1, 2000 and January 31, 2001). Hospitals were ranked on each indicator, with those in the lowest 20th percentile receiving a score of 0 and the remainder receiving a score of 1. Scores for individual indicators were then summed for each hospital and divided by the number of relevant indicators to provide an evidence-based score (EBS) and a clinical outcome score.


Ten process and six clinical outcome indicators were identified. Hospital-level summary scores ranged from 0.14 to 1.0 for evidence-based processes and from 0.17 to 1.0 for clinical outcomes. Evidence-based score and clinical outcome score were independent (r = 0.12, P = 0.32). There was a small positive association between evidence-based score and caseload (r = 0.33, P = 0.005) but clinical outcome score and caseload were unrelated (r = 0.11, P = 0.36).


Evidence-based score and clinical outcome score address different aspects of quality of care. The wide variability of hospitals' outcome scores and an association of evidence-based score and caseload indicate that simple scores may be useful in audit and feedback.

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