Oesophago-gastric Cancer National Audit Context Page

The Oesophago-gastric cancer audit is managed as a partnership from The Association of Upper Gastrointestinal Surgeons of Great Britain & Ireland (AUGIS), British Society of Gastroenterologists (BSG), Royal College of Radiologists (RCR), The Clinical Effectiveness Unit at the Royal College of Surgeons of England and NHS Digital. Patients with Oesophago-Gastric (OG) cancer, both curative and palliative, and oesophageal High-grade Glandular Dysplasia (HGD) are eligible for inclusion.  Measures include a number of procedures, post-operative mortality rate and length of stay.

More up-to-date data may be available at: www.nogca.org.uk/trust-results

Metrics:

Case ascertainment

• Rationale: the proportion of all eligible patients captured by the audit in the sampling period reflects the quality of participation of this hospital in this audit. The comparison is made against Hospital Episode Statistics data.
• Guideline/mapping: there is no national guideline related to case ascertainment and the audit does not currently specify an aspirational threshold.
• Graph/relative performance: there is no graphical display for this metric; the hospital’s performance should be compared against the national aggregate.
• Quality improvement prompt question: consider the metrics below in the context of case ascertainment – particularly where ascertainment is low – and should prompt questions about the quality of audit participation.

1. Crude proportion of patients treated with curative intent

This metric is defined at cancer network level; the network can represent several Trusts/hospitals [‘cancer units’]; the result can therefore be used a marker for the effectiveness of care at network level; better co-operation between hospitals within a network would be expected to produce better results

• Rationale: patients are more likely to have a curative treatment plan if they are diagnosed early (which may reflect access to diagnostic services such as endoscopy) and have their care discussed promptly in a specialist cancer network MDT. This metric is known to vary across cancer networks.
• Guideline/mapping: there is no national guideline related to the proportion of curative treatment in oesophago-gastric cancer surgery.
• Graph/relative performance: statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate, ‘red circle’ means that the hospital’s performance is statistically significantly worse than the national average and ‘grey box’ means that there is no statistically significant difference between them; caution is needed with interpretation because the metric is defined at cancer network level and it is not adjusted for case mix.
• Quality improvement prompt question: ‘red circle’ (statistically worse) status should prompt questions about the quality of access to diagnostic services for suspected oesophago-gastric cancer and whether there are any difficulties in accessing the specialist cancer network MDT as well as actions which the Trust has taken to improve its curative treatment proportion.

2. Risk-adjusted proportion of patients diagnosed after an emergency admission

This metric is defined at cancer network level; the network can represent several Trusts/hospitals [‘cancer units’]; the result can therefore be used a marker for the effectiveness of care at network level; better co-operation between hospitals within a network would be expected to produce better results.

• Rationale: patients diagnosed after an emergency admission are more likely to undergo palliative treatment. This metric may reflect differences in patient populations, in referral thresholds (such as 2-week wait times), in diagnostic access (such as endoscopy) and in the efficiency of the specialist cancer network MDT process. The metric is known to be variable across cancer networks. This metric uses casemix adjustment to ensure that hospitals dealing with sicker patients are compared fairly against those with a less complex case mix.
• Guideline/mapping: there is no national guideline related to the proportion of oesophago-gastric cancer diagnosed after emergency admissions.
• Graph/relative performance: casemix adjusted statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate, ‘red circle’ means that the hospital’s performance is statistically significantly worse than the national average and ‘grey box’ means that there is no statistically significant difference between them.
• Quality improvement prompt question: ‘red circle’ (statistically worse) status should prompt questions about the quality of access to diagnostic services for suspected oesophago-gastric cancer and the effectiveness of the specialist cancer network MDT as well as actions which the Trust has taken to reduce the proportion of emergency diagnoses.

3. Risk-adjusted 90-day post-operative mortality rate

Following a potentially curable cancer resection; this metric is only applicable to hospitals where curative surgery is performed [‘specialist cancer centres’]

• Rationale: death is the most serious outcome after oesophago-gastric cancer surgery and is known to vary across regions. A 90-day period is used because this captures outcomes of complicated cases (such as those with prolonged critical care support). This metric uses casemix adjustment to ensure that hospitals dealing with sicker patients are compared fairly against those with a less complex case mix.
• Guideline/mapping: there is no national guideline related to mortality after oesophago-gastric cancer surgery.
• Graph/relative performance: risk-adjusted funnel-plot cross-section; this shows the position of the Trust relative to 95% and 99.8% control limits. The grey zone means that the hospital’s performance is not statistically significantly different to the national average. Outside the grey zone means that the performance is different to the national average.
• Quality improvement prompt question: ‘orange’ (caution) or ‘red’ (alarm) outlier status should prompt questions about actions which the Trust has taken to reduce their mortality rates following oesophago-gastric cancer surgery.