Search

Objectives: To evaluate the prognosis of patients who underwent surgery for invasive bladder cancer and to search for prognostic factors., Methods: The files of all the patients who underwent radical or partial cystectomy for invasive bladder cancer between 1992 and 2014 were reviewed. The effect of various prognostic factors was evaluated by uni- and multivariate analyses., Results: A total of 160 patients were included in the study and were followed for a median period of 25.5 months after surgery. The overall 2 years and 5 years survival rates were 70% and 61.2% respectively. The disease-free 2 years and 5 years survival rates were 64.4% and 61.9% respectively. The overall 2 years and 5 years survival rates of patients with disease limited to the bladder (≥T2N0) were 88.2% and 82.4% and of patients with disease extending beyond the bladder (≤T3N0) 56.5% and 45.7% respectively. Factors that were found to be significantly associated with overall survival were: TNM stage, co-morbidity (Charlson 6-11) and the tumor's diameter. No association was found between: disease presentation, smoking habits, positive cytology, the tumor being primary or secondary, variant histology, the presence of endophytic growth pattern, the presence of CIS, hydronephrosis, positive lymph nodes on pre-operative imaging, surgery type (radical or partial cystectomy) and adjuvant chemotherapy., Conclusions: The survival rates of the locally treated patients match the reported rates in the literature. Tumors' T stage were found to be the strongest prognostic factor. Tumors' diameter was found to be an independent prognostic factor. This is reported here for the first time in the literature.

High quality healthcare necessitates taking appropriate steps to promote quality. One of the major tools used to promote quality in healthcare is clinical quality indicators. This paper briefly reviews major organizations dealing with quality indicators, in primary care as well as hospital medicine, in Israel and worldwide. This review includes international and national organizations, including organizations dedicated to quality indicators in nursing and pharmacy. Major organizations active in developing quality indicators have detailed Internet websites that allow the reader to learn about the indicator set they use. These websites could be used to develop new indicators for community and hospital medicine in Israel. The review indicates the worldwide achievements in promoting quality in health, and shows that clinical quality indicators are a major component in clinical quality improvement in many countries.

Background: Equitable distribution of healthcare resources and fair assessments of providers' performance necessitates adjusting for case-mix. The feasibility and validity of applying case-mix measures, based on inpatient and outpatient diagnoses, has yet to be tested in Israel., Aims: Assessment of the feasibility and validity of applying the Johns-Hopkins University Adjusted Clinical Groups (JHU-ACG) case-mix system, using diagnoses from hospitalizations or physician visits, at Clalit Health Services (CHS)., Methods: A representative sample of 117,355 enrollees during 2006. The distribution of ACG morbidity groups and relative resource weights in CHS and the degree to which it corresponds to ACGs' distribution in other countries was examined. The degree to which ACGs can explain utilization of primary and specialty care in CHS was determined., Results: ACGs explained a large percent of the variance in primary care and specialist visits (R2 = 38-54%), better than age and gender alone (R2 =12-13%). A high degree of correlation was found between the distribution of the population into ACG groups in CHS and samples from Canada or the United States (r = 0.91), and between the relative resource use for each ACG at CHS compared to the Canadian and US samples (r = 0.78-0.98)., Conclusions: The JHU-ACG case-mix system can be applied in the Largest healthcare organization in Israel based on diagnoses generated at hospitalizations and physician visits. The system can now be applied for a variety of purposes, including resource allocation according to medical need, and for conducting fair assessments of providers' performance, which are currently being tested by CHS.

The quality indicators program in the community has existed in Clalit Health Services for over a decade. As a part of this program, approximately 70 evidence-based quality indicators have been defined, in 11 different domains. The indicators relate to preventive medicine (immunizations, early detection of diseases, e.g. colorectal cancer, breast cancer, hypertension, chronic renal failure), chronic disease management (diabetes, hyperlipidemia, ischemic heart disease, asthma, congestive heart failure), care of the elderly (prevention of repeated hospitalizations) and child care (obesity detection, anemia detection and treatment). The indicators program is founded on one of the worldwide leading information systems, based on a common data warehouse with data regarding sociodemographic factors, purchase of medications, health services utilization, laboratory and imaging data, as well as a unique, validated registry of chronic diseases. The program has led to progress in several domains, including control of diabetes and hyperlipidemia, pneumococcal vaccination and early detection of colorectal cancer. The program narrowed the gaps and reduced inequalities between the Arab and Jewish populations, and between socioeconomic levels. The improvement in quality indicators is based on teamwork of physicians, nurses, other health professionals and administrative staff. The day-to-day work and the major effort invested in Clalit's enrollees are reflected in the continuing improvement in clinical quality.