Quality of Dutch integrated head and neck cancer care: Measurement and evaluation.

Abstract

173 Background: Oncologic care is very complex, and delivery of integrated care with optimal alignment and collaboration of several disciplines is crucial. To monitor and effectively improve high-quality integrated oncologic care, a dashboard of valid and reliable quality indicators (QIs) is indispensable. A set of QIs is developed specifically for head and neck cancer (HNC) patients from three perspectives: patients (development of indicators from patient perspective, including the first results, are described in the abstract "PROMs and PREMs in Dutch integrated head and neck cancer care: Measurements and evaluation"), medical specialist and allied health professionals. This presentation concerns the first results from medical and allied health professional perspective. Methods: QIs on process, structure and outcome of care, were developed using an evidence based method: the Rand modified Delphi method. Data was collected in nine Dutch hospitals nearly 1,500 patients (November 2014 - December 2016). Indicators were calculated on national and hospital level and corrected for case-mix using SPSS. Results: The final set contained 5 outcome indicators from both perspectives, 13 and 18 process indicators from the perspective of medical specialists and allied health professionals respectively, and three structure indicators from the perspective of allied health professionals. Besides, 10 case-mix factors were selected. Current practice assessment, in 1263 patients, produced high scores on integrated care indicators, e.g., the percentage of patients discussed in multidisciplinary team meeting before start of the treatment (93%) and availability of a treatment plan (99%). However, involvement of dental teams (range 57 – 100%) and malnutrition screening (range 8-35%) could be improved in most hospitals. In addition, most hospitals did not meet the standard of 80% on patients starting with treatment within 30 days. Conclusions: The quality of integrated multidisciplinary care for patients with head and neck cancer in the Netherlands is already high on some aspects, but varied between hospitals and shows room for improvement. This study can be an example for other oncologic diseases where integrated care is necessary.