Methodological issues in the use of guidelines and audit to improve clinical effectiveness in breast cancer in one United Kingdom health region
Identifieur interne : 00A606 ( Main/Exploration ); précédent : 00A605; suivant : 00A607Methodological issues in the use of guidelines and audit to improve clinical effectiveness in breast cancer in one United Kingdom health region
Auteurs : Cmj Bell ; M. Ma ; S. Campbell ; I. Basnett ; A. Pollock ; I. TaylorSource :
- European Journal of Surgical Oncology [ 0748-7983 ] ; 2000.
English descriptors
- KwdEn :
Abstract
Aims: To develop a system to improve and monitor clinical performance in the management of breast cancer patients in one United Kingdom health region. Design: An observational study of the changes brought about by the introduction of new structures to influence clinical practice and monitor change. Setting: North Thames (East) Health region, comprising seven purchasing health authorities and 21 acute hospitals treating breast cancer. Subjects: The multi-disciplinary breast teams in 21 hospitals and an audit sample of 419 (28%) of the breast cancer patients diagnosed in 1992 in the region. Interventions Evidence-based interventions for changing clinical practice: regional guidelines, senior clinicians acting as «opinion leaders», audit of quality rather than cost of services, ownership of data by clinicians, confidential feed-back to participants and education. Outcome measures: Qualitative measures of organizational and behavioural change. Quantitative measures of clinical outcomes compared to guideline targets and to results from previous studies within this population. Results: Organizational changes included the involvement, participation of and feedback to 16 specialist surgeons and their multidisciplinary teams in 21 hospitals. Regional clinical guidelines were developed in 6 months and the dataset piloted within 9 months. The audit cycle was completed within 2 years. The pilot study led to prospective audit at the end of 2 years for all breast cancers in the region and a 15-fold increase in high quality clinical information for these patients. Changes in clinical practice between 1990 and 1992 were observed in the use of chemotherapy (up from 17–23%) and axillary surgery (up from 46–76%). Conclusions: The approach used facilitated rapid change and found a balance between local involvement (essential for sustainability within a hospital setting) and regional standardization (essential for comparability across hospitals). The principles of the approach are generalized to other cancers and to other parts of the UK and abroad.
Url:
DOI: 10.1053/ejso.1999.0755
Affiliations:
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Design: An observational study of the changes brought about by the introduction of new structures to influence clinical practice and monitor change. Setting: North Thames (East) Health region, comprising seven purchasing health authorities and 21 acute hospitals treating breast cancer. Subjects: The multi-disciplinary breast teams in 21 hospitals and an audit sample of 419 (28%) of the breast cancer patients diagnosed in 1992 in the region. Interventions Evidence-based interventions for changing clinical practice: regional guidelines, senior clinicians acting as «opinion leaders», audit of quality rather than cost of services, ownership of data by clinicians, confidential feed-back to participants and education. Outcome measures: Qualitative measures of organizational and behavioural change. Quantitative measures of clinical outcomes compared to guideline targets and to results from previous studies within this population. Results: Organizational changes included the involvement, participation of and feedback to 16 specialist surgeons and their multidisciplinary teams in 21 hospitals. Regional clinical guidelines were developed in 6 months and the dataset piloted within 9 months. The audit cycle was completed within 2 years. The pilot study led to prospective audit at the end of 2 years for all breast cancers in the region and a 15-fold increase in high quality clinical information for these patients. Changes in clinical practice between 1990 and 1992 were observed in the use of chemotherapy (up from 17–23%) and axillary surgery (up from 46–76%). Conclusions: The approach used facilitated rapid change and found a balance between local involvement (essential for sustainability within a hospital setting) and regional standardization (essential for comparability across hospitals). The principles of the approach are generalized to other cancers and to other parts of the UK and abroad.</div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Basnett, I" sort="Basnett, I" uniqKey="Basnett I" first="I" last="Basnett">I. Basnett</name><name sortKey="Bell, Cmj" sort="Bell, Cmj" uniqKey="Bell C" first="Cmj" last="Bell">Cmj Bell</name><name sortKey="Campbell, S" sort="Campbell, S" uniqKey="Campbell S" first="S" last="Campbell">S. Campbell</name><name sortKey="Ma, M" sort="Ma, M" uniqKey="Ma M" first="M" last="Ma">M. Ma</name><name sortKey="Pollock, A" sort="Pollock, A" uniqKey="Pollock A" first="A" last="Pollock">A. Pollock</name><name sortKey="Taylor, I" sort="Taylor, I" uniqKey="Taylor I" first="I" last="Taylor">I. Taylor</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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