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To improve patient care, insight into actual performance is necessary Requirements for measuring:

Instruments for measuring the quality of care for cancer patients Rosella Hermens, senior-researcher , IQ healthcare , Nijmegen, the Netherlands. To improve patient care, insight into actual performance is necessary Requirements for measuring:

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To improve patient care, insight into actual performance is necessary Requirements for measuring:

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  1. Instruments for measuring the quality of care for cancer patientsRosella Hermens, senior-researcher,IQ healthcare, Nijmegen, the Netherlands

  2. To improve patient care, insight into actual performance is necessary Requirements for measuring: valid & reliable quality indicators to measure performance; Quality indicators: ‘explicitlydefined and measurable elements of practice performance for which there is evidence or consensus that they can be used to assess the quality of care, and hence change the quality of care provided’ (Lawrence 1997) How to develop valid and reliable quality indicators, particularly in cancer care? Introduction

  3. Optimal quality of cancer care How do you reach that? • Define optimal quality of cancer care • Use evidence based guidelines & literature • Select quality indicators systematically • Measure actual performance • Find deviations from optimal quality and barriers • Improve

  4. Optimal quality of cancer care Definition optimal quality of cancer care: • Care for patients with cancer has becoming more complex; • Many different professionals involved in actual care; • To prevent fragmentation  integrated, patient-centred care INTEGRATED, PATIENT-CENTRED CARE: Main principles (review Ouwens et al. 2005) • patient-centred care instead of disease-centred care; • multidisciplinary collaboration in optimal functioning teams; • optimal organization of care processes; • evidence-based performances. AND:  continuous quality improvement .

  5. Quality indicators forintegrated cancer care • Patient-centeredness • Communication & Information: CAHPS surveys: Consumer Assessment of Healthcare Providers and Systems): https://www.cahps.ahrq.gov • Multidisciplinary collaboration: • multidisciplinary team meetings with optimal team climate (TCI-questionnaire; Ouwens et al); • discussion of every patient; • integrated medical patient record; • Organisation(continuity and coordination): • One contact person for patients; • One director of patients’ treatment process; • ‘Acceptable’ waiting- and throughput times; • Outcome: • Mortality • Toxicity/complications (post-surgery, post-radiotherapy, post-chemotherapy) • 1, 2, 5-years Survival • PROMs (patient-related outcome measures as quality of life: Euroqol 5) • Medical - technical performance Systematicdevelopment Development of Generic Quality Indicators for Patient-Centered Cancer Care by Using a RAND Modified Delphi Method. Uphoff, Eleonora; Wennekes, Lianne; Punt, Cornelis; MD, PhD; Grol, Richard; Wollersheim, Hub; MD, PhD; Hermens, Rosella; Ottevanger, Petronella; MD, PhD Cancer Nursing. 35(1):29-37, January/February 2012.

  6. Systematic development: requirements

  7. Example: Measurement qualityindicators Non-Hodgkinlymphomas Project Dutch Cancer Society (KWF) – Drs. Lianne Wennekes • 20 quality indicators Non-Hodgkinlymfoom (NHL) developed and measured, particularlymedical – technical performance and organisation of care • 3 Dutch regions • 22 hospitals • 20 patients per hospital • medical record search

  8. Results quality indicators NHL Largedifferences in performances between different Dutch regions and hospitals (Wennekes et al. JCO, 2011)

  9. Wennekes L, Ottevanger PB, Raemaekers JM, Schouten HC, de Kok MW, Punt CJ, Grol RP, Wollersheim HC, Hermens RP. Development and Measurement of Guideline-Based Indicators forPatientsWithNon-Hodgkin’sLymphoma. J. ClinOncol2011; 29 (11):1436-1444. R.P.M.G. Hermens, M. Ouwens, Y. Vonk-Okhuijsen, Y. van der Wel, V.C. Tjan-Heijnen, L.D. van den Broek, V.K. Ho, M.L. Janssen-Heijnen, H.J. Groen, R.P.T.M. Grol, H.C.H. Wollersheim. Development of quality indicators for diagnosis and treatment of patientswithnon-smallcelllung cancer: a first step towardimplementing a multidisciplinary, evidence-basedguideline. Lung Cancer 2006; 54(1): 117-124 Uphoff, Eleonora; Wennekes, Lianne; Punt, Cornelis; MD, PhD; Grol, Richard; Wollersheim, Hub; MD, PhD; Hermens, Rosella; Ottevanger, Petronella; MD, PhD. Development of Generic Quality Indicators for Patient-Centered Cancer Care by Using a RAND Modified Delphi Method. Cancer Nursing. 35(1):29-37, January/February 2012. Ouwens M, Hermens R, Hulscher M, Vonk-Okhuijsen S, Tjan-Heijnen V, Termeer R, Marres H, Wollersheim H, Grol R. Development of indicators forpatient-centred cancer care Support Care Cancer. 2010 January; 18(1): 121–130. More information

  10. Realise….. ‘I am not interested in measurement per se. I am obsessed by improvement and the role measurement has in that process.’ Don Berwick, IHI* * Institute for Healthcare Improvement

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