Process Indicators Outshine Outcome Measures: Assessing Hospital Quality of Care in Breast Cancer Treatment

Process Indicators Outshine Outcome Measures: Assessing Hospital Quality of Care in Breast Cancer Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Process Indicators Outshine Outcome Measures: Assessing Hospital Quality of Care in Breast Cancer Treatment Mengyang Liu, Ruize Guo, Jingkun Li, Chao Wang, Lei Yu, Meina Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4455370/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Aug, 2024 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Reporting the results of quality indicators can narrow the gap in the quality of care between hospitals. While most studies rely on outcome indicators , they may not accurately measure the quality of care. Process indicators are not only strongly associated with treatment outcomes, but are also more sensitive to whether patients are treated accurately, enabling timely intervention. In this study, we aimed to investigate whether process indicators can provide a more reasonable assessment of evaluating hospital quality of care compared to outcome indicators. Methods: Data were sourced from the Specific Disease Medical Service Quality Management and Control System in China. A total of 113,942 patients with breast cancer treated in 298 hospitals between January 2019 and April 2023 were included in this study. The rankability of 11 process indicators was calculated and used as a weight to create a new composite indicator. The composite indicators and outcome measures were compared using the O/E ratio categories. Finally, in order to determine the impact of different years on the results, a sensitivity analysis was conducted using bootstrap sampling. Results: The rankability (ρ) values of the eleven process indicators showed significant differences, with the highest ρ value for preoperative cytological or histological examination before surgery (0.919). The ρ value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score (ρ = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite 1 scores and 140 (46.98%) for preoperative cytological or histological examination before surgery. Conclusion: Process indicators are more appropriate than outcome indicators for assessing the quality of hospital breast cancer care, which may contribute to quality improvement efforts. Biological sciences/Cancer Biological sciences/Cancer/Breast cancer quality assessment rankability breast cancer bootstrap Full Text Additional Declarations No competing interests reported. Supplementary Files AppendixFigure.docx AppendixTable.docx Cite Share Download PDF Status: Published Journal Publication published 19 Aug, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 28 Jul, 2024 Reviews received at journal 27 Jul, 2024 Reviews received at journal 21 Jul, 2024 Reviews received at journal 05 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers invited by journal 02 Jul, 2024 Editor assigned by journal 02 Jul, 2024 Editor invited by journal 28 May, 2024 Submission checks completed at journal 25 May, 2024 First submitted to journal 21 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4455370","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":310461369,"identity":"c5995dc2-f7cf-45f0-8834-032448c897de","order_by":0,"name":"Mengyang Liu","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mengyang","middleName":"","lastName":"Liu","suffix":""},{"id":310461372,"identity":"feb97858-609f-409e-9068-57994b45546b","order_by":1,"name":"Ruize Guo","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ruize","middleName":"","lastName":"Guo","suffix":""},{"id":310461375,"identity":"27efbccb-bb55-4be0-a957-fb7bd95cb4c9","order_by":2,"name":"Jingkun Li","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingkun","middleName":"","lastName":"Li","suffix":""},{"id":310461377,"identity":"636e07c0-64ed-4f1c-8c46-8e26420b7282","order_by":3,"name":"Chao Wang","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chao","middleName":"","lastName":"Wang","suffix":""},{"id":310461378,"identity":"56e04e7a-e823-4596-bf66-16dd6df823a9","order_by":4,"name":"Lei Yu","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Yu","suffix":""},{"id":310461380,"identity":"4d1ad3b4-d4bd-40d8-8cce-8a7f542e31ff","order_by":5,"name":"Meina Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACPmYQacDAIM/efPBBQkUNYS1sMC2GPceSDR6cOUaEFjjrho+Z5MMWZiK0sPOYbvhQcEeecQaPWUViAxsDf3t3AgGH8ZjdnGHwzLBduq3sRuIOGQaJM2c3ENRym8fgMGPjnMPbbiSeYWMwkMglQssfg8P2DTcSzAoS25iJ1MJgcDix4UaKGQORWtjKbvYYHE7eCAxkiYQzx3gI+oWfH+iFH38O284HRuXHHxU1cvztvfi1YAAe0pSPglEwCkbBKMAKAHxISNEo6aYuAAAAAElFTkSuQmCC","orcid":"","institution":"Harbin Medical University","correspondingAuthor":true,"prefix":"","firstName":"Meina","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-05-21 13:56:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4455370/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4455370/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-70474-8","type":"published","date":"2024-08-19T15:57:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63300437,"identity":"b7f5d5c8-b771-406c-b5ab-3207ef4a98a2","added_by":"auto","created_at":"2024-08-26 16:14:23","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":649936,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4455370/v1_covered_01cd3f70-c07e-4331-ab85-a5cd8e2723fb.pdf"},{"id":57814458,"identity":"10c15e5a-7ff7-40e6-8cf7-4b8a97a22420","added_by":"auto","created_at":"2024-06-06 03:57:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":406324,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixFigure.docx","url":"https://assets-eu.researchsquare.com/files/rs-4455370/v1/f529efbdc096e5feb1686c0f.docx"},{"id":57814457,"identity":"033c4c9f-0b1f-404a-bdd6-5fdb078ba532","added_by":"auto","created_at":"2024-06-06 03:57:26","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23863,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-4455370/v1/857e840c4bb83dd646889573.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Process Indicators Outshine Outcome Measures: Assessing Hospital Quality of Care in Breast Cancer Treatment","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"quality assessment, rankability, breast cancer, bootstrap","lastPublishedDoi":"10.21203/rs.3.rs-4455370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4455370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Reporting the results of quality indicators can narrow the gap in the quality of care between hospitals. While most studies rely on outcome indicators , they may not accurately measure the quality of care. Process indicators are not only strongly associated with treatment outcomes, but are also more sensitive to whether patients are treated accurately, enabling timely intervention. In this study, we aimed to investigate whether process indicators can provide a more reasonable assessment of evaluating hospital quality of care compared to outcome indicators.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Data were sourced from the Specific Disease Medical Service Quality Management and Control System in China. A total of 113,942 patients with breast cancer treated in 298 hospitals between January 2019 and April 2023 were included in this study. The rankability of 11 process indicators was calculated and used as a weight to create a new composite indicator. The composite indicators and outcome measures were compared using the O/E ratio categories. Finally, in order to determine the impact of different years on the results, a sensitivity analysis was conducted using bootstrap sampling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The rankability (ρ) values of the eleven process indicators showed significant differences, with the highest ρ value for preoperative cytological or histological examination before surgery (0.919). The ρ value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score (ρ = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite 1 scores and 140 (46.98%) for preoperative cytological or histological examination before surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Process indicators are more appropriate than outcome indicators for assessing the quality of hospital breast cancer care, which may contribute to quality improvement efforts.\u003c/p\u003e","manuscriptTitle":"Process Indicators Outshine Outcome Measures: Assessing Hospital Quality of Care in Breast Cancer Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-06 03:57:21","doi":"10.21203/rs.3.rs-4455370/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-28T07:13:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-27T10:26:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-21T23:12:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-05T14:20:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142987293076988582831429082146942719089","date":"2024-07-04T19:30:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296823533828031925288841839956940788573","date":"2024-07-04T10:47:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334001256823498696114736326153021544018","date":"2024-07-02T09:35:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-02T08:53:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-02T08:07:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-28T07:36:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-25T05:20:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-21T13:55:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c429115e-3e71-4bcb-9e1f-a7e212f7cc6d","owner":[],"postedDate":"June 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":32808359,"name":"Biological sciences/Cancer"},{"id":32808360,"name":"Biological sciences/Cancer/Breast cancer"}],"tags":[],"updatedAt":"2024-08-26T16:05:33+00:00","versionOfRecord":{"articleIdentity":"rs-4455370","link":"https://doi.org/10.1038/s41598-024-70474-8","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-08-19 15:57:55","publishedOnDateReadable":"August 19th, 2024"},"versionCreatedAt":"2024-06-06 03:57:21","video":"","vorDoi":"10.1038/s41598-024-70474-8","vorDoiUrl":"https://doi.org/10.1038/s41598-024-70474-8","workflowStages":[]},"version":"v1","identity":"rs-4455370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4455370","identity":"rs-4455370","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}