Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan

a questionnaire survey of departments registered in the National Clinical Database

Yasushi Toh, Hiroyuki Yamamoto, Hiroaki Miyata, Mitsukazu Gotoh, Masayuki Watanabe, Hisahiro Matsubara, Yoshihiro Kakeji, Yasuyuki Seto

Research output: Contribution to journalArticle

Abstract

Background: It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Methods: A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Results: Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer “performed at the doctor’s discretion” showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. Conclusions: The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.

Original languageEnglish
JournalEsophagus
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

Fingerprint

Guideline Adherence
Esophageal Neoplasms
Practice Guidelines
Esophagectomy
Japan
Databases
Certification
Therapeutics
Quality Improvement
Odds Ratio
Drug Therapy
Mortality
Surgeons
Surveys and Questionnaires

Keywords

  • Board-certified surgeon
  • Esophageal cancer
  • Esophagectomy
  • Quality indicator
  • Questionnaire survey

ASJC Scopus subject areas

  • Gastroenterology

Cite this

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title = "Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan: a questionnaire survey of departments registered in the National Clinical Database",
abstract = "Background: It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Methods: A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Results: Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6{\%}) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer “performed at the doctor’s discretion” showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. Conclusions: The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.",
keywords = "Board-certified surgeon, Esophageal cancer, Esophagectomy, Quality indicator, Questionnaire survey",
author = "Yasushi Toh and Hiroyuki Yamamoto and Hiroaki Miyata and Mitsukazu Gotoh and Masayuki Watanabe and Hisahiro Matsubara and Yoshihiro Kakeji and Yasuyuki Seto",
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language = "English",
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T1 - Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan

T2 - a questionnaire survey of departments registered in the National Clinical Database

AU - Toh, Yasushi

AU - Yamamoto, Hiroyuki

AU - Miyata, Hiroaki

AU - Gotoh, Mitsukazu

AU - Watanabe, Masayuki

AU - Matsubara, Hisahiro

AU - Kakeji, Yoshihiro

AU - Seto, Yasuyuki

PY - 2019/1/1

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N2 - Background: It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Methods: A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Results: Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer “performed at the doctor’s discretion” showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. Conclusions: The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.

AB - Background: It remains unknown how much institutional medical structure and process of implementation of clinical practice guidelines for esophageal cancers can improve quality of surgical outcome in Japan. Methods: A web-based questionnaire survey was performed for departments registered in the National Clinical Database in Japan from October 2014 to January 2015. Quality indicators (QIs) including structure and process indicators (clinical practice guideline adherence) were evaluated on the risk-adjusted odds ratio for operative mortality (AOR) of the patients using registered cases in the database who underwent esophagectomy and reconstruction in 2013 and 2014. Results: Among 916 departments which registered at least one esophagectomy case during the study period, 454 departments (49.6%) responded to the questionnaire. Analyses of 6661 cases revealed that two structure QIs (certification of training hospitals by Japan Esophageal Society and presence of board-certified esophageal surgeons) were associated with significantly lower AOR (p < 0.001 and p = 0.005, respectively). One highly recommended process QI regarding preoperative chemotherapy had strong tendency to associate with lower AOR (p = 0.053). In two process QIs, the answer “performed at the doctor’s discretion” showed a significant negative impact on prognosis, suggesting importance of institutional uniformity. Conclusions: The medical institutional structure of board-certified training sites for esophageal surgeons and of participation of board-certified esophageal surgeons improves surgical outcome in Japan. Establishment of appropriate QIs and their uniform implementation would be crucial for future quality improvement of medical care in esophagectomy.

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