Factors associated with quality of care for patients with pancreatic cancer in Australia

Objectives: To develop a composite score for the quality of care for patients with pancreatic cancer in Australia; to determine whether it was affected by patient and health service-related factors; to assess whether the score and survival were correlated. Design,participants and setting: We reviewed medical records of patients diagnosed with pancreatic cancer during July 2009 e June 2011 and notified to the Queensland and New South Wales cancer registries. Design and main outcome measures: Participants were allocated proportional quality of care scores based on indicators derived from a Delphi process,ranging from 0 (lowest) to 1 (highest quality care). Associations between patient and health service-related factors and the score were tested by linear regression,and associations between the score and survival with KaplaneMeier and Cox proportional hazards methods. Results: Proportional quality of care scores were assigned to 1571 patients. Scores for patients living in rural areas were significantly lower than for those in major cities (adjusted difference,11%; 95% CI,8e13%); they were higher for patients in the least socio-economically disadvantaged areas (v most disadvantaged areas: 8% higher; 95% CI,6e11%),who were younger,had better Eastern Cooperative Oncology Group performance status,or who first presented to a hospital with a high pancreatic case volume. Higher scores were associated with improved survival; after adjusting for patient-related factors each 10 percentage point increase in the score reduced the risk of dying by 6% (hazard ratio,0.94; 95% CI,0.91e0.97). Conclusion: Geographic category of residence may influence the quality of care received by patients with pancreatic cancer,and survival could be improved if they received optimal care.