Implementation of a comprehensive cancer plan. A health planning experience.

Here we describe the working method used to implement an Integrated Cancer Health Plan in Andalusia (Spain) and to set out some of the lines of work for improving quality of care and health network planning. Four main initial considerations were made: (1) work must be centred on patients and respect for their autonomy; (2) cancer requires action at every healthcare level; (3) integration of expert professionals is to be encouraged; and (4) relevant information and data should be systematically used for planning. Two operative approaches were also established: structured participation and evidence-based healthcare. This methodology was used in various planning programmes, largely in relation to healthcare resources. In this article, as examples, we describe the development of two types of programmes: one for radiotherapy equipment and another for the management of lymphoedema in breast cancer patients. Analysis of results obtained against cancer is always controversial. It is necessary to review the healthcare structure used in terms of effectiveness and excellence. Comprehensive or integrated health plans are a useful model for a wide-ranging and multi-level approach to cancer. The structured and real participation of experts and an evidence- based healthcare strategy proved very useful in this public health planning experience.

Oncology care planning. Elements for care quality and management improving.

BACKGROUND: The improvement of care quality depends on the education and skills of the professional team as well as on an adequate work method, which uses the right instruments of clinical management such as medical history, registers or protocols. OBJECTIVES: Defining standardized criteria related to the oncology care quality and applying them to a group of hospitals within the framework of continuous improvement establishing comparisons among them. MATERIAL AND METHODS: Information taken from 14 Andalusian public hospitals, in 2003 and first semester of 2004. A total of 35 variables were collected from official sources, validated studies and surveys as a starting point, grouped in four main issues (medical history, protocols, central commission and tumour sub-commissions), delays (diagnostic, treatment and early diagnostic), variability (cytostatics and radiotherapy), research (clinical trials and financed projects) and work loads. OUTCOMES: In 3 out of 14 centers medical histories are unique for each patient. In average, 3 of the 6 most frequent tumor locations have joint protocols. The delays for the diagnostic test vary from 1 to 23 days and from 11 to 29 days for treatments. The consumption increase of 12 cytostatics was of 71.8% (average of 602,413 euro per hospital). The average rate of patients undergoing irradiation was of 34 %. 109 clinical trials were approved (a centre performes 26) and 20 projects were financed (Health Department, Consejería de Salud). The attendance pressure was of 140 patients per specialist in MO and RO (maximum of 241 and 214 respectively and minimum of 85 and 69). COMMENTS: The information gathered in this study shows a diverse nature, and meets items not always taken into consideration, in a global way, but with a clearly complementary nature. No doubt, they offer a scenery that deepens into the complexity of which today means the improvement of the quality of the non-monographic hospital centres that attend patients suffering from cancer. It finally offers instruments for the improvement of the clinical management which we understand it is of certain usefulness.