ArticleBMJ quality & safety2018
Variation and statistical reliability of publicly reported primary care diagnostic activity indicators for cancer: a cross-sectional ecological study of routine data.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Pooled it
- Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis.Health technology assessment (Winchester, England) · 2020Pooled it
- Variation in the use of primary care-led investigations prior to a cancer diagnosis: analysis of the National Cancer Diagnosis Audit.BMJ quality & safety · 2025Article
- The good, the bad and the ugly: What do we really do when we identify the best and the worst organisations?BMJ quality & safety · 2024Article
- Priorities for implementation research on diagnosing cancer in primary care: a consensus process.BMC health services research · 2023Article
- Stability of hospital quality indicators over time: A multi-year observational study of German hospital data.PloS one · 2023Observational
- Concordance with urgent referral guidelines in patients presenting with any of six 'alarm' features of possible cancer: a retrospective cohort study using linked primary care records.BMJ quality & safety · 2022Article
- Do presenting symptoms, use of pre-diagnostic endoscopy and risk of emergency cancer diagnosis vary by comorbidity burden and type in patients with colorectal cancer?British journal of cancer · 2022Article
- Associations between general practice characteristics and chest X-ray rate: an observational study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Observational
- Association of Medicare Advantage Star Ratings With Racial, Ethnic, and Socioeconomic Disparities in Quality of Care.JAMA health forum · 2021Article
- Combined Serum DKK3 and Circulating CD133 Cells as Prognostic Biomarkers for Ovarian Cancer Patients.OncoTargets and therapy · 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
- Associations between general practice characteristics with use of urgent referrals for suspected cancer and endoscopies: a cross-sectional ecological study.Family practice · 2019Observational
- Reliability of hospital scores for the Cancer Patient Experience Survey: analysis of publicly reported patient survey data.BMJ open · 2019Article
- Availability and use of cancer decision-support tools: a cross-sectional survey of UK primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Article
- Ranking hospital performance based on individual indicators: can we increase reliability by creating composite indicators?BMC medical research methodology · 2019Article
- Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare.BMC health services research · 2019Article
- Trends in lung cancer emergency presentation in England, 2006-2013: is there a pattern by general practice?BMC cancer · 2018Article
- Missing data and chance variation in public reporting of cancer stage at diagnosis: Cross-sectional analysis of population-based data in England.Cancer epidemiology · 2018Article
- Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018Article
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesRecent public reporting initiatives in England highlight general practice variation in indicators of diagnostic activity related to cancer. We aimed to quantify the size and sources of variation and the reliability of practice-level estimates of such indicators, to better inform how this information is interpreted and used for quality improvement purposes.
designEcological cross-sectional study.
settingEnglish primary care.
participantsAll general practices in England with at least 1000 patients.
main outcome measuresSixteen diagnostic activity indicators from the Cancer Services Public Health Profiles.
resultsMixed-effects logistic and Poisson regression showed that substantial proportions of the observed variance in practice scores reflected chance, variably so for different indicators (between 7% and 85%). However, after accounting for the role of chance, there remained substantial variation between practices (typically up to twofold variation between the 75th and 25th centiles of practice scores, and up to fourfold variation between the 90th and 10th centiles). The age and sex profile of practice populations explained some of this variation, by different amounts across indicators. Generally, the reliability of diagnostic process indicators relating to broader populations of patients most of whom do not have cancer (eg, rate of endoscopic investigations, or urgent referrals for suspected cancer (also known as 'two week wait referrals')) was high (≥0.80) or very high (≥0.90). In contrast, the reliability of diagnostic outcome indicators relating to incident cancer cases (eg, per cent of all cancer cases detected after an emergency presentation) ranged from 0.24 to 0.54, which is well below recommended thresholds (≥0.70).
conclusionsUse of indicators of diagnostic activity in individual general practices should principally focus on process indicators which have adequate or high reliability and not outcome indicators which are unreliable at practice level.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.