A starting point in the evaluation of the outcome of care: an example using cancer registry information

Abstract

Many health services worldwide are paying increasing attention to the evaluation of care. However, most studies in the past have concentrated on structure and process instead of outcome. The objective of this paper is to show how a fairly simple technique can provide a possible feedback loop to a health service system. A study on patients with lung cancer in East Anglia, UK is used as an example. Using information which was more or less routinely collected in cancer registration, the study showed that there was no significant difference between the survival of patients seen in the eight districts in East Anglia. Adjustment by the use proportional hazard modelling for prognostic factors including age, sex, histological type, stage and whether active treatment was given did not alter the outcome. This finding was slightly unexpected in view of the presumed (yet not documented) variation in enthusiasm and expertise among the districts. Such a result should be seen as a starting point for studies designed to examine the effects of the level of care provided and resource use on the length and quality of survival. While the methodology requires refinement and substantial local difficulties may arise, development of similar researches on the outcome of care should be encouraged in Hong Kong.