{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:30:11Z","timestamp":1764883811886,"version":"3.46.0"},"reference-count":40,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Erasmus Initiative Smarter Choices for Better Health","award":["no award\/grant number"],"award-info":[{"award-number":["no award\/grant number"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To construct a data-driven composite from (a subset of) currently used quality indicators for oesophagogastric cancer surgery and to evaluate whether this approach enhances the reliability of between-hospital comparisons on outcome relative to the expert-driven composite indicator \u2018textbook outcome (TO)\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In this retrospective cohort study, we applied Item Response Theory (IRT) to construct a data-driven continuous composite indicator reflecting a single latent variable\u2014the quality of surgical care\u2014and estimated latent variable scores for all individual patients. Reliability was compared between the expert-driven (TO) and data-driven (IRT) composite indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All Dutch hospitals providing oesophagogastric cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All patients who underwent oesophagectomy (n=3588) or gastrectomy (n=1782) between 2018 and 2022 as registered in the Dutch Upper GI Cancer Audit (DUCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We evaluated the reliability of between-hospital comparisons using \u2018rankability\u2019, which quantifies the proportion of observed variation in indicator scores between hospitals not attributable to chance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven out of 15 quality indicators were included in the IRT composite indicator. Most of the patients were assigned the artificial maximum of the continuous quality score (ie, ceiling effect), resulting in similar average hospital scores. Relative to TO, rankability increased when using the IRT composite for oesophagectomy (57% vs 41%) but declined for gastrectomy (38% vs 47%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The selected seven quality indicators for oesophageal and gastric cancer surgery represent a single latent variable but are not yet optimal for differentiating surgical care quality due to ceiling effects. Despite using fewer indicators, the continuous IRT score showed a promising increase in rankability for oesophagectomy, suggesting that data-driven composite indicators may enhance hospital benchmarking reliability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104832","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T06:20:55Z","timestamp":1762410055000},"page":"e104832","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Reliability of data-driven versus expert-driven composite indicators in between-hospital comparisons on quality of oesophagogastric cancer surgery: a population-based retrospective cohort study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-0064","authenticated-orcid":false,"given":"Margrietha","family":"van der Linde","sequence":"first","affiliation":[{"name":"Department of Public Health, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Eijkenaar","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Zuid Holland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurits R","family":"Visser","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands"},{"name":"Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bas PL","family":"Wijnhoven","sequence":"additional","affiliation":[{"name":"Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hester F","family":"Lingsma","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn AH","family":"Oude Voshaar","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"2025120413260279000_15.11.e104832.1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200301001-00004"},{"key":"2025120413260279000_15.11.e104832.2","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5034\/inquiryjrnl_46.02.172","article-title":"Quality-based payment for medical groups and individual physicians","volume":"46","author":"Robinson","year":"2009","journal-title":"Inquiry"},{"key":"2025120413260279000_15.11.e104832.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-2-200801150-00006"},{"key":"2025120413260279000_15.11.e104832.4","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.healthpol.2017.08.004","article-title":"Insurees\u2019 preferences in hospital choice-A population-based study","volume":"121","author":"Schuldt","year":"2017","journal-title":"Health Policy"},{"key":"2025120413260279000_15.11.e104832.5","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X10386799"},{"key":"2025120413260279000_15.11.e104832.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410120089033"},{"key":"2025120413260279000_15.11.e104832.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs.2010.048058"},{"key":"2025120413260279000_15.11.e104832.8","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcp169"},{"key":"2025120413260279000_15.11.e104832.9","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.jval.2019.12.014","article-title":"Effect of Case-Mix and Random Variation on Breast Cancer Care Quality Indicators and Their Rankability","volume":"23","author":"Vos","year":"2020","journal-title":"Value Health"},{"key":"2025120413260279000_15.11.e104832.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-007669"},{"key":"2025120413260279000_15.11.e104832.11","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3552"},{"key":"2025120413260279000_15.11.e104832.12","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00259-022-06002-5","article-title":"Defining textbook outcome for selective internal radiation therapy of hepatocellular carcinoma: an international expert study","volume":"50","author":"Gregory","year":"2023","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025120413260279000_15.11.e104832.13","doi-asserted-by":"crossref","unstructured":"Martin-Martinez MA , Andreu-Sanchez JL , Sanchez-Alonso F , et al . 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