Benchmarking our urological care: It’s just the beginning

In this issue of CUAJ, readers will come across an interesting exercise in performance measurement focused on the surgical management of kidney cancer. Lawson et al1 report on a benchmarking project within the Canadian Kidney Cancer information system (CKCis), a mostly prospective database from a cohort of patients managed in 16 different tertiary care hospitals across Canada. The clinical-pathological variables collected within the dataset allow significant depth and breadth in this quality review of surgical care. The authors assessed each hospital’s performance on a number of previously defined quality indicators: processes of care, such as use of partial nephrectomy for localized tumours, as well as specific outcomes, including warm ischemia time and complications. In order to create benchmarks to compare “performance,” the authors used the rich variables in the dataset to control for case-mix and formulate indirect standardization of indicators (conceptually the average performance across the centres). Using this methodology, they demonstrate some variability in the observed-to-expected performance in participating hospitals, including the use of nephron-sparing techniques in those at higher risk of future renal impairment