General practice performance in referral for suspected cancer

influence of number of cases and case-mix on publically reported data

Peter Murchie, Anika Chowdhury, Sarah Mary Smith, Neil Campbell, Amanda Jane Lee, David Linden, Christopher David Burton

Research output: Contribution to journalArticle

7 Citations (Scopus)
10 Downloads (Pure)

Abstract

Background: Publicly available data show variation in GPs use of urgent suspected cancer referral pathways. We investigated if this could be due to small numbers of cancer cases and random case-mix, rather than true variation in performance.
Methods: We analysed individual practice urgent suspected cancer referral (USC) detection (number of practice’s cancer detected via USC) and conversion rates (number of practice’s USC referrals which are cancer) in routinely collected data on cancer referrals from GP practices in all of England (over four years) and North-east Scotland (over seven years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation.
Results: Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47).
Conclusion: Much apparent variation in GPs’ use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used and more appropriate and robust methods should be developed.
Original languageEnglish
Pages (from-to)1791-1798
Number of pages8
JournalBritish Journal of Cancer
Volume112
Issue number11
Early online date16 Apr 2015
DOIs
Publication statusPublished - 2015

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Diagnosis-Related Groups
General Practice
Referral and Consultation
Neoplasms
Scotland
England
Meta-Analysis

Keywords

  • cancer diagnosis
  • prumary care
  • referral
  • healthcare quality assurance

Cite this

@article{bf5840b9484b47cbb7957e9c34549d3c,
title = "General practice performance in referral for suspected cancer: influence of number of cases and case-mix on publically reported data",
abstract = "Background: Publicly available data show variation in GPs use of urgent suspected cancer referral pathways. We investigated if this could be due to small numbers of cancer cases and random case-mix, rather than true variation in performance. Methods: We analysed individual practice urgent suspected cancer referral (USC) detection (number of practice’s cancer detected via USC) and conversion rates (number of practice’s USC referrals which are cancer) in routinely collected data on cancer referrals from GP practices in all of England (over four years) and North-east Scotland (over seven years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Results: Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20{\%} (IQR 17 to 24) and after 100 cases was 44{\%} (IQR 40 to 47). Conclusion: Much apparent variation in GPs’ use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used and more appropriate and robust methods should be developed.",
keywords = "cancer diagnosis, prumary care, referral, healthcare quality assurance",
author = "Peter Murchie and Anika Chowdhury and Smith, {Sarah Mary} and Neil Campbell and Lee, {Amanda Jane} and David Linden and Burton, {Christopher David}",
note = "The study sponsor is the University of Aberdeen.",
year = "2015",
doi = "10.1038/bjc.2015.110",
language = "English",
volume = "112",
pages = "1791--1798",
journal = "British Journal of Cancer",
issn = "0007-0920",
publisher = "Nature Publishing Group",
number = "11",

}

TY - JOUR

T1 - General practice performance in referral for suspected cancer

T2 - influence of number of cases and case-mix on publically reported data

AU - Murchie, Peter

AU - Chowdhury, Anika

AU - Smith, Sarah Mary

AU - Campbell, Neil

AU - Lee, Amanda Jane

AU - Linden, David

AU - Burton, Christopher David

N1 - The study sponsor is the University of Aberdeen.

PY - 2015

Y1 - 2015

N2 - Background: Publicly available data show variation in GPs use of urgent suspected cancer referral pathways. We investigated if this could be due to small numbers of cancer cases and random case-mix, rather than true variation in performance. Methods: We analysed individual practice urgent suspected cancer referral (USC) detection (number of practice’s cancer detected via USC) and conversion rates (number of practice’s USC referrals which are cancer) in routinely collected data on cancer referrals from GP practices in all of England (over four years) and North-east Scotland (over seven years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Results: Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47). Conclusion: Much apparent variation in GPs’ use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used and more appropriate and robust methods should be developed.

AB - Background: Publicly available data show variation in GPs use of urgent suspected cancer referral pathways. We investigated if this could be due to small numbers of cancer cases and random case-mix, rather than true variation in performance. Methods: We analysed individual practice urgent suspected cancer referral (USC) detection (number of practice’s cancer detected via USC) and conversion rates (number of practice’s USC referrals which are cancer) in routinely collected data on cancer referrals from GP practices in all of England (over four years) and North-east Scotland (over seven years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Results: Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47). Conclusion: Much apparent variation in GPs’ use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used and more appropriate and robust methods should be developed.

KW - cancer diagnosis

KW - prumary care

KW - referral

KW - healthcare quality assurance

U2 - 10.1038/bjc.2015.110

DO - 10.1038/bjc.2015.110

M3 - Article

VL - 112

SP - 1791

EP - 1798

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 11

ER -