Table 5.
Assessment of adherence with the pancreatic cancer quality indicators at the patient and hospital levels
| Quality indicator | Patient-level assessment (%) | Hospital-level assessment* (%) |
| Number of patients | 49 065 | |
| Number of hospitals | 1134 | |
| Patient-level measures | ||
| IF a patient undergoes cancer-directed resection, THEN clinical Stage, pathological stage, histology, size, grade, margin status, number of lymph nodes examined and positive, and timing of adjuvant therapy should be documented† | 65.6 | 25.3 |
| IF a patient has clinical stage I or II disease, THEN the patient should undergo resection or have a valid reason documented for not undergoing resection‡ | 52.9 | 6.9 |
| IF a patient undergoes cancer-directed resection, THEN adjuvant chemotherapy with or without radiation should be considered or administered, or a valid reason should be documented for not receiving adjuvant therapy‡ | 67.1 | 37.3 |
| IF a patient has clinical stage IV disease, THEN cancer-directed surgery should not be done | 97.2 | 99.9 |
| IF a patient does not undergo resection, THEN chemotherapy or chemoradiation should be considered/administered or a valid reason should be documented for not receiving non-surgical therapy‡ | 69.7 | 9.5 |
| IF a patient is to receive treatment, THEN the time from diagnosis to surgery or first treatment should be less than 2 months | 94.8 | 80.9 |
| IF a patient undergoes cancer-directed resection, THEN the margins should be macroscopically clear | 91.3 | 50.4 |
| IF a patient undergoes cancer-directed resection, THEN ≥10 regional lymph nodes should be resected and pathologically evaluated | 49.6 | 11.8 |
| Hospital-level measures | ||
| IF an institution performs pancreatic cancer surgery, THEN the hospital risk-adjusted perioperative mortality should be less than 5%§ | ‖ | 66.0 |
| IF an institution performs pancreatic cancer surgery, THEN the institution should perform ≥12 per year | ‖ | 6.8 |
*
Proportion of hospitals that were adherent with the measure in ≥90% of their patients in 2004–2005.
†
The measure requiring documentation of tumor size was excluded from the composite measure because it is not currently required to be reported by the Commission on Cancer and the American Joint Committee on Cancer.
‡
Valid reasons for not undergoing treatment include documentation of severe comorbidities, advanced age, or patient refusal.
§
Risk adjustment models included sex, age, race, stage, type of pancreatectomy, and Charlson comorbidity score.
‖
These indicators cannot be assessed for individual patients.