Process indicators outshine outcome measures: assessing hospital quality of care in breast cancer treatment in China

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. Our study aims to investigate whether process indicators provide a more reasonable assessment of hospital quality of care compared to outcome indicators. 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 retrospective 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. The rankability ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>ρ</mml:mi></mml:math> ) values of the eleven process indicators showed significant differences, with the highest <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>ρ</mml:mi></mml:math> value for preoperative cytological or histological examination before surgery (0.919). The <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>ρ</mml:mi></mml:math> value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>ρ</mml:mi></mml:math> = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite scores and 140 (46.98%) for preoperative cytological or histological examinationbefore surgery. Process indicators are more suitable than outcome indicators for assessing the quality of breast cancer care in hospitals. Healthcare providers can use process indicators to identify specific areas for improvement, thereby driving continuous quality improvement efforts.