University of Twente Student Theses


Pattern comparison of Quality Indicators on a national and hospital level in the Netherlands and Norway

Smits, T.E.P (2018) Pattern comparison of Quality Indicators on a national and hospital level in the Netherlands and Norway.

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Abstract:Introduction: In recent years, the quality of health care has become a subject of public debate. This has given rise to the need for hospitals to openly provide indicators of the quality of care. Both the multidisciplinary NABON Breast cancer Audit in the Netherlands and the Norwegian Breast Cancer Quality Registry in Norway have established indicator sets. Aim: This study aims to analyze six quality indicators, defined by the Dutch NABON. Methods: All female patients diagnosed with DCIS or Invasive breast cancer in the Netherlands and Norway between 2012 and 2016, were included. Six quality indicators were calculated and hospital performance of both visualized with a funnel plot and given with a 95% CI. Case-mix correction for characteristics of the patient (age and stage) were performed. Results: Breast cancer care is given in 92 hospitals in the Netherlands. In Norway it is given in 65 hospitals, subdivided into 20 area hospitals. The Dutch data contains 78,126 breast tumors; 10,764 DCIS lesions and 67,362 invasive breast cancers. In Norway, the data contains 18,715 breast tumors; 1,753 DCIS lesions and 17,675 invasive breast cancers. The percentage of patients with unknown tumor resection margins in the first breast-conserving surgery (indicators 6 and 7) showed a higher average in Norway (DCIS 41.4% (95% CI 37-44), invasive breast cancer 14.2% (95% CI 14-15)) than in the Netherlands (DCIS 19.1% (95% CI 18-20), invasive breast cancer 1.5% (95% CI 1-2)). The percentage of patients who have conserved a breast contour after operative treatment for invasive M0 breast cancer showed a similar pattern for the Netherlands and Norway (indicator 8). The remaining indicators (9,10 and 12) showed limited differences between the countries. Conclusion: Case-mix adjustments reduce the variation in outcome of the four quality indicators in the Netherlands and Norway (indicator 8 till 12).
Item Type:Essay (Master)
Cancer Registry Norway, Oslo, Norway
Faculty:TNW: Science and Technology
Subject:02 science and culture in general
Programme:Health Sciences MSc (66851)
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