A dynamic clinical pathway for the treatment of patients with early breast cancer is a tool for better cancer care: implementation and prospective analysis between 2002-2010.

BACKGROUND: Due to increasing the complexity of breast cancer treatment it is of paramount importance to develop structured care in order to avoid a chaotic and non-consistent management of patients. Clinical pathways, a result of the adaptation of the documents used in industrial quality management namely the Standard Operating Procedures, can be used to improve efficiency and quality of care. They also aim to re-centre the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently. METHODS: The effect of the implementation and prospective systematic evaluation of a clinical care pathway for the management of patients with early breast cancer in a single breast unit is evaluated over a long time interval (between 2002 and 2010). Annual analysis of predefined clinical outcome measures, service indicators, team indicators, process indicators and financial indicators was performed. Pathway quality control meetings were organized at least once a year. Systematic feedback was given to the team members, and if necessary the pathway was adapted according to evidence based literature data and in house pathway related data in order to improve quality. RESULTS: The annual number of patients included in the pathway (289 vs. 390, P <0.01), proportion of patients with Tis-T1 tumors (42% vs. 58%, P <0.01), negative lymph nodes (44% vs. 58%, P <0.01) and no metastases at diagnosis (91.5% vs. 95.9%) has risen significantly between 2002 and 2010. Evolution of mandatory quality indicators defined by EUSOMA shows a significant improvement of quality of cancer care. Particularly, the proportion of patients having anti-hormonal therapy (84.8% vs. 97.4%, P = 0.002) and adjuvant chemotherapy according to the guidelines (72% vs. 95.6%, P = 0.028) increased dramatically. Patient satisfaction improved significantly (P <0.05). Progression free 4-year survival was significantly higher for all patients, for T1 tumors only and for T2-T4 tumors only, treated between 2006 to 2008 compared to between 1999 to 2002 and 2003 to 2005 (P = 0.006, P = 0.05, P = 0.06, respectively). Overall 4-year survival of the entire population treated between 2006 and 2008 was significantly better (P = 0.05). CONCLUSIONS: Although the patient characteristics changed over the years due to better screening, this clinical pathway and regular audit of quality indicators for the treatment of patients with operable breast cancer proved to be important tools to improve the quality of care, patient satisfaction and outcome.

Improving quality of electronic data registration for clinical pathways at the regional hospital Sint Augustinus Antwerp (Flanders-Belgium): A case study.

The hospital management wishes to guarantee a high quality of care by improving processes. Th improvement is based upon performance measurements documented by care providers using an order communication, planning and result reporting system. The nursing process was integrated in clinical pathways. The documented data to guide the nursing care process and used for quality improvement are off poor quality. The documentation process was improved by setting up a structured organisation of data collection into the HIS, based on a clear procedure, discussed with care providers to make sure the data collection was achievable A control mechanism of measured data has been organised. The responsibility for gathering correct data was identified and a structured follow up was organised. Feed back and discussion of data and information of the responsible team was organised. After the implementation of this method more accurate measurements were noticed. More correct data for additional improvement of the process were used. Based upon these structured approach other processes will be improve.

CORDIET - Healthcare: Extracting knowledge from electronic patient record data.

In this paper we propose the software system CORDIET-Healthcare which we are currently developing in collaboration with the Katholieke Universiteit Leuven, Moscow Higher School of Economics and the GZA-hospital group located in Antwerp. The main aim of this system is to offer healthcare management staff a user-friendly and powerful data analysis environment. Using state of the art techniques from computer science and mathematics we show how CORDIET-Healthcare can be used to gain insight in existing care processes and reveal actionable knowledge which can be used to improve the current way of working.