Measuring quality of care for colorectal cancer care : comprehensive feedback driving quality improvement

Abstract

Data from clinical audits such as the Dutch Surgical Colorectal Audit, can be used for valid and meaningful feedback information, which may support improvement of quality of care. First, we showed that the continuous feedback cycle of clinical auditing has an autonomous, positive effect on the quality of surgical care. Second, we describe how data from clinical audits can be used to monitor and improve national practice and performance in colorectal cancer care, especially for high-risk patients. Third, we describe how clinical auditing can be used for the evaluation and monitoring of the implementation of new techniques, such as laparoscopic surgery, on a national level. We demonstrate that, although there is a large hospital variation in the use of laparoscopic surgery, this does not explain the variation in outcome. Last, we investigate how data can be used to evaluate quality of care and give transparency to all stakeholders. As the various aspects of quality of care can be strongly interrelated, quality of care may best be represented using composite-measures. These composite measures can be used by all stakeholders to evaluate quality of care as a whole. The methodologies described in this thesis may be used in many other clinical audits.