ABSTRACT
BACKGROUND: The management of patients with head and neck cancer is complex, and implementation of an integrated care program might improve the quality of care. METHODS: A prospective before-after study was performed in 1 clinic for head and neck oncology on 311 adults with head and neck cancer to evaluate an integrated care program. RESULTS: Scores on the integrated care indicators showed that the implementation of the integrated care program led to relevant improvements, eg, waiting time for diagnostic procedures less than 10 days (improvement of 37%), support for stopping smoking (+37%), nutrition support (+44%), assessment of CT and MRI scans by a an expert radiologist (+23%), and number of patients in contact with the specialist nurses (+37%). The program had no relevant effects on the outcome indicators. CONCLUSION: An integrated care program can improve several aspects of the management of patients with head and neck cancer.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Head and Neck Neoplasms/therapy , Patient-Centered Care/organization & administration , Quality Assurance, Health Care , Aged , Cohort Studies , Female , Humans , Male , Patient Satisfaction , Process Assessment, Health Care , Program Evaluation , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: In the current study, the authors focused on determinants influencing the quality of care and variations in the actual quality of integrated care for patients with nonsmall cell lung cancer (NSCLC) to estimate whether there is room for improvement. METHODS: The authors tested the quality of integrated care for 276 NSCLC patients with 14 quality indicators of professional (4 indicators), organizational (3 indicators), and patient-oriented quality (7 indicators). Patient characteristics and actual care data were derived from medical record data, patient-oriented care was derived from patient questionnaires, and professional and hospital characteristics were derived from questionnaires for professionals. The performance measure was the proportion of patients to whom the indicator applied who had positive scores on the indicator. Multilevel logistic regression analysis determined the influence of patient, professional, and hospital characteristics on care. RESULTS: With regard to professional quality, the proportions of patients who underwent fluorodeoxyglucose-positron emission tomography or cervical mediastinoscopy according to the guideline criteria were 88% and 84%, respectively. Only 50% of the biopsies were adequately obtained during mediastinoscopy, and in 3% of the patients with clinical stage III disease (based on the TNM classification) there was a search for brain metastases before the initiation of combination therapy. With regard to organizational quality, the diagnostic route of 79% of the patients was completed within 21 days; 51% of patients began therapy within 35 days and 57% were discussed during multidisciplinary consultation. All but 1 patient-oriented quality indicator scored /=20% with regard to 11 of the 14 indicators. The patient-related determinants "stage of disease," "age," and "comorbidity" were found to influence the indicator scores the most. CONCLUSIONS: The quality of integrated care (especially patient-oriented care) for NSCLC patients needs improvement. Patient characteristics appear to influence performance more than professional or hospital characteristics.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/therapy , Evidence-Based Medicine , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Practice Guidelines as Topic , Quality Indicators, Health Care , Adult , Age Distribution , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Middle Aged , Neoplasm Staging , NetherlandsABSTRACT
BACKGROUND: To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology. METHODS: We defined a set of indicators based on integrated care literature, national evidence-based guidelines for patients with head and neck cancer, and the opinions of professionals and patients. We tested this set regarding assessment of current practice and clinimetric characteristics. RESULTS: The final set consisted of 8 integrated care indicators and 23 specific indicators for patients with head and neck cancer. Current practice assessment produced high scores for the integrated care indicators, but the specific indicators showed room for improvement. The practice test showed that 9 indicators had good applicability. CONCLUSIONS: The indicators, while based on evidence-based guidelines and the principles of integrated care, should incorporate patients' opinions and include a practice test. Our results show that the quality of integrated care for patients with head and neck cancer could be improved.