{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T09:45:06Z","timestamp":1768038306473,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T00:00:00Z","timestamp":1559779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To examine associations between survival and adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines using an observed\u2010to\u2010expected (O\/E) ratio for greater adherence as a risk\u2010adjusted hospital measure of quality care in elderly patients treated for larynx cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER)\u2010Medicare data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with larynx cancer from 2004 to 2007 were evaluated using multivariate regression and survival analysis. A fit logistic regression model was used to calculate an O\/E ratio for guideline adherence for each hospital using quality indicators derived from NCCN guidelines for recommended treatment and stratified by hospital volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1,721 patients treated at 395 hospitals, 43.0% of patients received NCCN guideline\u2010adherent care. Low\u2010volume hospitals (N = 295) treating six or fewer cases treated 765 patients (44.5%), with a mean O\/E of 0.96 \u00b1 0.45. Hospitals treating more then six cases with an O\/E &lt;1 (N = 32) treated 284 patients (16.5%), with a mean O\/E of 0.77 \u00b1 0.18. Hospitals treating more than six cases with an O\/E \u22651 (N = 68) treated 672 patients (39.1%), with a mean O\/E of 1.17 \u00b1 0.11. Treatment at hospitals with an O\/E \u22651 was associated with improved survival (hazard ratio [HR] = 0.83 [95% confidence interval [CI]: 0.70 to 0.98]) and lower mean incremental treatment\u2010related costs (\u2212$3,009 [\u2212$5,226 to \u2212$791]) compared with hospitals with an O\/E &lt;1 (HR = 1.00 [0.80 to 1.24]) and the reference group of low\u2010volume hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A hospital\u2010specific O\/E for NCCN treatment guideline adherence, combined with a minimum case volume criterion, is associated with survival and treatment\u2010related costs in elderly patients with larynx cancer, and may be a feasible measure of larynx cancer quality of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA<\/jats:p><jats:p><jats:italic>Laryngoscope<\/jats:italic>, 130:672\u2013678, 2020<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28104","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T14:15:08Z","timestamp":1559830508000},"page":"672-678","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Observed\u2010to\u2010expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer"],"prefix":"10.1002","volume":"130","author":[{"given":"Warren C.","family":"Swegal","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Herbert","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Eisele","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of California Irvine  Irvine California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Bristow","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology Department of Obstetrics and Gynecology, University of California, Irvine Medical Center  Orange California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5134-9307","authenticated-orcid":false,"given":"Christine G.","family":"Gourin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,6,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410120089033"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.20.1747"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2001.117139"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa012337"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.7.721"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182329b97"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000375"},{"key":"e_1_2_6_9_1","unstructured":"The Leapfrog Group. 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