QUALITY INDICATORS TO ASSESS A COLORECTAL CANCER PREVENTION PROGRAM

Autor: Carmela Barrantes Serrano, Victoria Serra-Sutton, Mireia Espallargues Carreras
Rok vydání: 2013
Předmět:
Zdroj: International Journal of Technology Assessment in Health Care
ISSN: 1471-6348
0266-4623
DOI: 10.1017/s0266462313000020
Popis: Most prevention programs for colorectal cancer (CRC) are aimed at medium-risk populations and are included in population-based prevention strategies. The main inclusion criteria in this type of program is age (aged 50 and older without personal or family history of colorectal adenomas or CRC) (1,2). There is another risk group, made up generally of individuals at increased risk of developing CRC, which includes the following criteria: (i) individuals who carry mutations in certain genes, (ii) individuals with a family history of CRC, and (iii) individuals with a history of high-risk colorectal adenomatous polyps. Individuals in the group of carriers of mutations in specific genes represent between 3 percent and 5 percent of all patients diagnosed with CRC. In 2006, the High-Risk Clinic for Colorectal Cancer (HRC-CRC) (3;4), a new healthcare model for the prevention of CRC in a high-risk population, was created at the Hospital Clinic of Barcelona under the coordination of the Institute of Digestive and Metabolic Disorders. The Hospital Clinic of Barcelona is a reference, community, level 1, public teaching hospital in Catalonia with renowned capabilities, both nationally and internationally, in healthcare, research, innovation, and quality teaching. Catalonia is one of the seventeen autonomous regions in Spain with a regional administration and autonomous government and parliament. The HRC-CRC was funded by the Catalan Department of Health with the aim of implementing prevention strategies in populations at greater risk of CRC (individuals with a hereditary or individual predisposition to colorectal cancer such as Lynch syndrome, familial adenomatous polyposis, or advanced colorectal adenomas). The HRC-CRC is staffed with health professionals from the fields of gastroenterology, biochemistry and molecular genetics, pathology, clinical psychology, nursing, gastrointestinal surgery, oncology, and family and community medicine. The roles of this new healthcare model/program included the following main areas of healthcare: (i) to identify individuals at increased risk of developing CRC (mainly individuals referred from primary health care according to evidence-based criteria in relation to CRC risk factors of increased risk or other specialized services from their own hospital or from other hospitals; patients and users also access the program on their own initiative; (ii) to establish the risk of CRC in users with personal risk factors and/or a family history of CRC; (iii) to propose the most appropriate screening and surveillance prevention strategies; (iv) to carry out genetic counseling in hereditary forms of CRC, genetic testing, and psychological assessment; (5) to carry out additional endoscopic and radiological procedures for prevention, diagnostic; and/or therapeutic aims. In a first phase of implementation of the HRC-CRC, the Hospital Clinic of Barcelona, pending the incorporation of a secondary hospital, assumed the role of secondary and tertiary care provider, and was linked to two primary care centers, which took on the primary level functions of this new organizational model for the prevention of CRC. Tertiary level functions of this model consist mainly in the implementation of measures for genetic counseling and testing, and the performance of complex surgical or endoscopic procedures (e.g., Lynch syndrome). Secondary level functions include the management of high-risk forms of CRC requiring colonoscopies with a periodicity of less than 5 years (e.g., familial CRC) and the performance of conventional and therapeutic endoscopic procedures. Finally, functions at the primary care level consist in identifying populations at greater risk of CRC and the follow-up of users on the prevention program with intervals of over 5 years between colonoscopies (e.g., patients with non-advanced adenomas). Although the activities (clinical practice) of the HRC-CRC are evidence-based, to the best of our knowledge, no assessment of the quality of care and the benefits/risk of the prevention program on the user's health have been carried out (4;5). To date, no published study has been identified that evaluates the quality of care of a CRC prevention program in a high-risk population taking into account all the healthcare processes involved. The primary objective of this study was to implement a set of indicators to assess the quality of care of a new healthcare model for the prevention of colorectal cancer in a high-risk population (at baseline and independently). Furthermore, as a secondary objective, factors related to adherence to screening and surveillance prevention strategies in this model were analyzed. Several studies have evidenced that demographic factors such as user gender, age, and health status are related to their adherence to screening and surveillance prevention strategies (6;7). The assessment of factors relating to adherence to this type of strategies in the HRC-CRC was considered relevant to assess the construct validity of three proposed indicators measuring patient-centered care.
Databáze: OpenAIRE
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