Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics

• Published in: BMC cancer Vol. 15; no. 1; p. 578
• Main Authors: Stienen, Jozette J.C., Hermens, Rosella P.M.G., Wennekes, Lianne, van de Schans, Saskia A.M., van der Maazen, Richard W.M., Dekker, Helena M., Liefers, Janine, van Krieken, Johan H.J.M., Blijlevens, Nicole M.A., Ottevanger, Petronella B.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 08.08.2015; BioMed Central Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer therapies; Comorbidity; Data collection; Evidence-based medicine; Female; Guideline Adherence; Health Personnel; Health Promotion and Disease Prevention; Hospitalization; Hospitals; Humans; Lymphatic system; Lymphoma; Lymphoma, Non-Hodgkin - diagnosis; Lymphoma, Non-Hodgkin - epidemiology; Lymphoma, Non-Hodgkin - therapy; Male; Medical records; Medical research; Medicine, Experimental; Medicine/Public Health; Middle Aged; Oncology; Pathology; Patient Care - standards; Patient compliance; Patients; Professionals; Quality Indicators, Health Care; Randomized Controlled Trials as Topic; Regression analysis; Research Article; Risk Factors; Surgical Oncology; Tumors; Variables; Young Adult; Netherlands; Non-Hodgkin’s lymphoma; Determinants; Oncology; Hematology; Hospital variation; Guidelines
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-015-1547-8

Background The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care. Methods Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data. Results Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain. Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner. Conclusion Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.