Measuring and improving quality of care in surgical oncology

Abstract

This thesis shows that quality of care in surgical oncology varies by provider and is partly based on differences in procedural volume and other attributes of hospitals. Especially for low-volume high-risk surgical procedures concentration of services in hospitals with better outcomes (outcome-based referral) can lead to dramatic improvement in short- as well as long-term outcomes. Casemix- and reliability adjustments are essential in the evaluation of quality of care. In addition, an integrated approach, in which several determinants of outcome are combined, might provide a more valid instrument to assess the quality of complex clinical processes. Clinical audit combines several ways to improve quality of care. It stimulates guideline adherence and provides clinicians with continuous and timely feedback on their performance, in relation to a national benchmark. Feedback itself has proven to be very effective, though the most important benefits of clinical audit can be found in the identification and appreciation of clinical processes that lead to better outcomes. This knowledge can be transferred to all practices treating such patient groups, improving outcome on a population-level. In addition, transparency of reliable, meaningful, hospital-specific outcome information, can catalyst the continuous process of quality improvement, steer patients to the right hospitals and reduce the costs of healthcare.