ArticleBritish journal of cancer2015
General practice performance in referral for suspected cancer: influence of number of cases and case-mix on publicly reported data.
Article in British journal of cancer, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies.International journal of environmental research and public health · 2022Pooled it
- Pooled it
- Article
- Outcomes from colonoscopy following referral from New Zealand general practice: a retrospective analysis.BMC gastroenterology · 2021Article
- Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- Influences of socioeconomic deprivation on GPs' decisions to refer patients to cardiology: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Article
- Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites.British journal of cancer · 2018Article
- Variation and statistical reliability of publicly reported primary care diagnostic activity indicators for cancer: a cross-sectional ecological study of routine data.BMJ quality & safety · 2018Article
- Knowledge or noise? Making sense of General Practitioners' and Consultant use of 2-week-wait referrals for suspected cancer.British journal of cancer · 2017Article
- Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study.BMJ (Clinical research ed.) · 2015Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPublicly available data show variation in GPs' use of urgent suspected cancer (USC) referral pathways. We investigated whether this could be due to small numbers of cancer cases and random case-mix, rather than due to true variation in performance.
methodsWe analysed individual GP practice USC referral detection rates (proportion of the practice's cancer cases that are detected via USC) and conversion rates (proportion of the practice's USC referrals that prove to be cancer) in routinely collected data from GP practices in all of England (over 4 years) and northeast Scotland (over 7 years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation.
resultsCorrelations 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).
conclusionsMuch 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.
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