Kwaliteit van de oncologische zorg: ‘Why the real world matters’

Oratie uitgesproken door Prof. Dr. Michel W.J.M. Wouters bij de aanvaarding van het ambt van bijzonder hoogleraar Kwaliteit van de oncologische zorg, in het bijzonder data-gedreven verbetering van patiëntuitkomsten aan de Universiteit Leiden op maandag 16 mei 2022.Oratie uitgesproken door Prof. Dr. Michel W.J.M. Wouters bij de aanvaarding van het ambt van bijzonder hoogleraar Kwaliteit van de oncologische zorg, in het bijzonder data-gedreven verbetering van patiëntuitkomsten aan de Universiteit Leiden op maandag 16 mei 2022.LUMC / Geneeskund

Measuring and improving quality of care in surgical oncology

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.Dutch Cancer Society, Netherlands Cancer Institute, Leiden University Medical Center, GlaxoSmithKline BV, Roche Netherlands BV, Agendia NV, Sanofi-Aventis BV, Jan van der Kroon en Guus Corver.UBL - phd migration 201

Supporting Lung Cancer Patients With an Interactive Patient Portal:Feasibility Study

BACKGROUND: MyAVL is an interactive portal for cancer patients that aims to support lung cancer patients. OBJECTIVE: We aimed to evaluate the feasibility and usability of the patient portal and generate preliminary evidence on its impact. METHODS: Lung cancer patients currently or recently treated with curative intent could use MyAVL noncommittally for 4 months. Feasibility, usability, and preliminary impact (ie, patient activation, quality of life, and physical activity) were studied by means of questionnaires, a focus group, and analysis of user log data. RESULTS: We included 37 of 123 eligible patients (mean age 59.6 years). The majority of responses (82%) were positive about using MyAVL, 69% saw it as a valuable addition to care, and 56% perceived increased control over their health. No positive effects could be substantiated on the impact measures. CONCLUSIONS: MyAVL appears to be a feasible and user-friendly, multifunctional eHealth program for a selected group of lung cancer patients. However, it needs further improvements to positively impact patient outcomes

eHealth for Breast Cancer Survivors: Use, Feasibility and Impact of an Interactive Portal

Background: MijnAVL is an interactive portal including patient education, overview of appointments, access to the electronic medical records (EMR), patient-reported outcomes, plus feedback and physical activity support. Objective: With this study we aimed to evaluate the use, feasibility, and impact of MijnAVL among breast cancer survivors. Methods: We included survivors currently or recently treated with curative intent, who completed questions on sociodemographics, patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for four months. Log data were collected retrospectively and participants completed questions on acceptability, satisfaction, and the PAM, SF-36 and IPAQ. Results: Ninety-two women (mean age 49.5 years, 59% on-treatment) participated, with a mean number of logins of 8.7. Overview of appointments (80% of participants) and access to the EMR (90%) were most frequently used and most highly valued. Average website user satisfaction was 3.8 on a 5-point scale. Although participants reported having more knowledge and experiencing more control of their situation after using MijnAVL, PAM scores did not change significantly. Three domains of the SF-36 (role functioning - emotional, mental health, and social functioning) and median vigorous physical activity improved significantly over time. The burden of MijnAVL for professionals was limited. Conclusions: User experiences were positive and exposure to MijnAVL was accompanied by improvements in three quality of life domains and vigorous physical activity. Tailored features may be needed to enhance the usefulness and efficacy of MijnAVL. Research with a controlled design is needed to confirm our findings

Towards cancer rehabilitation at home: design of a telerehabilitation service for lung cancer patients

Although lung resection still provides the best long-term outcome for lung cancer, it is also associated with a considerable decay in physical and psychosocial health status. If not controlled, these symptoms can hamper postsurgical recovery, and lead to unscheduled healthcare use. This study aimed to determine the clinical relevance of and functional requirements for a telerehabilitation (TR) service to support recovery following lung resection. A modular remote monitoring and treatment service, consisting of an ambulant health monitoring module and an online exercise program, was developed to improve survivorship care following lung surgery through a user-centred design approach. Results from the requirement elicitation indicate positive intentions of both patients and professionals to use the RMT service as part of current care practice. In early phase evaluation usability and technical reliability of the developed system was found high. Future research should establish level of adoption of the system by the end users, as well as the effects on post-surgery recovery when integrated with current healthcare processes

Quality indicators for hip fracture care, a systematic review

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.Trauma Surger

Failure-to-rescue after colorectal surgery in the Netherlands

Analysis and Stochastic

Variation in Surgical Treatment of Abdominal Aortic Aneurysms With Small Aortic Diameters in the Netherlands

Objective: To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. Background: Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. Methods: All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. Results: In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. Conclusions: Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage

Oncoplastic breast conserving surgery: is there a need for standardization?: Results of a nationwide survey

Introduction: The NABON Breast Cancer Audit showed that more than 70% of the Dutch women undergoing surgery for breast cancer maintained their breast contour by breast-conserving surgery (BCS) or by immediate reconstruction after ablative surgery. The proportion of oncoplastic surgery applied in patients undergoing breast-conserving treatment remains unknown. The aim of our study was to assess the need for standardization of oncoplastic breast-conserving surgery (OPBCS) in an attempt to enable measurement of the quality of OPBCS. Methods: To gain a better understanding of current practice in OPBCS, we sent a questionnaire to all breast surgeons in The Netherlands who are members of the breast surgery working group (n = 134). Results: A total of 60 breast surgeons, representing different hospitals in The Netherlands, responded. 61.7% of the breast surgeons performed BCS on 60–100% of their patients. 68.3% responded that BCS was performed using OPS techniques in up to 40% of their patients. OPBCS was defined as level I volume displacement by 45.2% of the breast surgeons and as BCS performed by a breast surgeon and plastic surgeon together by 32.3% of the breast surgeons. 94.5% indicated that there is a need for standardization of the definition of OPBCS in The Netherlands. Conclusion: This study demonstrates that OPBCS is a major part of daily clinical practice of Dutch breast surgeons treating BC patients. Despite this, there is no clear definition of OPS in breast-conserving treatment in The Netherlands. Only after standardization can a classification code and quality indicator be initiated for OPBCS. Ultimately, this will facilitate improvement in quality of BC care. Analysis and support of clinical decision makin