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Is Textbook Outcome a valuable composite measure for short-term outcomes of gastrointestinal treatments in the Netherlands using hospital information system data? A retrospective cohort study
  1. Nèwel Salet1,2,
  2. Rolf H Bremmer2,
  3. Marc A M T Verhagen3,
  4. Vivian E Ekkelenkamp4,
  5. Bettina E Hansen5,6,
  6. Pieter J F de Jonge6,
  7. Rob A de Man6
  1. 1 VU University Medical Center Amsterdam, Amsterdam, The Netherlands
  2. 2 LOGEX, Amsterdam, The Netherlands
  3. 3 Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
  4. 4 Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands
  5. 5 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  6. 6 Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Rolf H Bremmer; rolf.bremmer{at}


Objective To develop a feasible model for monitoring short-term outcome of clinical care trajectories for hospitals in the Netherlands using data obtained from hospital information systems for identifying hospital variation.

Study design Retrospective analysis of collected data from hospital information systems combined with clinical indicator definitions to define and compare short-term outcomes for three gastrointestinal pathways using the concept of Textbook Outcome.

Setting 62 Dutch hospitals.

Participants 45 848 unique gastrointestinal patients discharged in 2015.

Main outcome measure A broad range of clinical outcomes including length of stay, reintervention, readmission and doctor–patient counselling.

Results Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for gallstone disease (n=4369), colonoscopy for inflammatory bowel disease (IBD; n=19 330) and colonoscopy for colorectal cancer screening (n=22 149) were submitted to five suitable clinical indicators per treatment. The percentage of all patients who met all five criteria was 54%±9% (SD) for ERCP treatment. For IBD this was 47%±7% of the patients, and for colon cancer screening this number was 85%±14%.

Conclusion This study shows that reusing data obtained from hospital information systems combined with clinical indicator definitions can be used to express short-term outcomes using the concept of Textbook Outcome without any excess registration. This information can provide meaningful insight into the clinical care trajectory on the level of individual patient care. Furthermore, this concept can be applied to many clinical trajectories within gastroenterology and beyond for monitoring and improving the clinical pathway and outcome for patients.

  • quality in healthcare
  • standards of care
  • process mapping
  • performance measures

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors NS and RHB collected the data. NS, RHB, MV and RdM drafted the manuscript and contributed to all other quality aspects of the study. BH was involved in the data analyses. PJdJ and VE performed critical revision of the manuscript. All authors read and approved the final manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RHB has currently and NS had previously a relevant connection to LOGEX (Amsterdam, The Netherlands) as employees. LOGEX offers healthcare analytics to medical specialists. MV, RdM, PJdJ, BH and VE have no relevant connection to LOGEX.

  • Patient consent Not required.

  • Ethics approval No ethical approval was required in this study due to patient anonymity in the database.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study brought together existing data obtained upon request and subject to license restrictions from a number of different sources. Due to the (commercially, politically, ethically) sensitive nature of the research, no source consented their data being retained or shared.

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