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

Objective: To 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 design: Retrospective 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.

Setting: 62 Dutch hospitals.

Participants: 45 848 unique gastrointestinal patients discharged in 2015.

Main outcome measure: A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor-patient counselling.

Results: Patients 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%.

Conclusion: This 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.

Keywords: performance measures; process mapping; quality in healthcare; standards of care.

Figure 1

Flow chart of included hospitals and corresponding patient trajectories. *Hospitals affiliated with LOGEX are included in this study. ERCP, endoscopic retrograde cholangiopancreatography; IBD, inflammatory bowel disease.

Figure 2

Distribution of the scores per indicator shown for 53 hospitals: (A) distribution of scores on doctor–patient contact prior to ERCP, (B) no second ERCP, (C) inpatient stay, (D) no CT scan after ERCP, (E) no readmission within 30 days, and (F) product of all criteria, defined as Textbook Outcome. ERCP, endoscopic retrograde cholangiopancreatography.

Figure 3

Specificity score per indicator. (A) ERCP for (1) doctor–patient contact prior to ERCP, (2) no second ERCP, (3) inpatient stay, (4) no CT scan after ERCP, (5) no readmission within 30 days, and per cent of all patients not meeting the five criteria. (B) IBD colonoscopy: (1) distribution of time scores between first consult and colonoscopy, (2) no second colonoscopy, (3) inpatient stay, (4) no emergency room (ER) admission after colonoscopy, (5) follow-up doctor–patient consult after colonoscopy, and per cent of all patients not meeting the five criteria. (C) Colon screening colonoscopies: (1) doctor–patient consult before colonoscopy, (2) no CT scan indicating complications, (3) no laboratory diagnostics indicating complications, (4) no inpatient admission after colonoscopy, (5) no ER admission after colonoscopy, and per cent of all patients not meeting the five criteria. ERCP, endoscopic retrograde cholangiopancreatography; IBD, inflammatory bowel disease; TO, Textbook Outcome.

Figure 4

Correlation between the total Textbook Outcome score and the individual indicators (A) doctor–patient contact prior to ERCP, (B) no second ERCP, (C) inpatient stay, (D) no CT scan after ERCP, (E) no admission within 30 days, and (F) the relation between hospital scores on no second ERCP and inpatient stay ≤7 days. ERCP, endoscopic retrograde cholangiopancreatography.

Figure 5

Distribution of the scores per indicator shown in 62 hospitals for inflammatory bowel disease (IBD): (A) distribution of time scores between first consult and colonoscopy, (B) no second colonoscopy, (C) inpatient stay, (D) no ER admission after colonoscopy, (E) follow-up doctor–patient consult after colonoscopy, (F) product of all criteria, defined as Textbook Outcome. ER, emergency room.

Figure 6

Distribution of the scores per indicator shown in 53 hospitals for colon cancer screening: (A) distribution of doctor–patient consult before colonoscopy, (B) no CT scan indicating complications, (C) no laboratory diagnostics indicating complications, (D) no inpatient admission after colonoscopy, (E) no ER admission after colonoscopy, (F) product of all criteria, defined as Textbook Outcome. ER, emergency room.