Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada,
Ann Surg Oncol. 2013 Dec;20(13):4067-72. doi: 10.1245/s10434-013-3218-9. Epub 2013 Aug 23.
Stakeholders suggest that integrating end users into the planning and execution of quality improvement interventions may more effectively close quality gaps. We tested if such an approach could improve the quality of colorectal cancer surgery in a large geographic region (i.e., LHIN4) in Ontario, Canada.
All LHIN4 surgeons who provide colorectal cancer surgery were invited to an October 2006 inaugural QICC-L4 workshop and subsequent workshops in 2008, 2010, and 2012. At workshops, surgeons selected clinically relevant quality markers for targeted improvement and interventions to achieve improvements. Selected markers included rates of colon and rectal radiology imaging, rate of pathology reporting of rectal radial margin distance, and rate of positive rectal radial margins. To date, implemented interventions have included audit and feedback, tailoring interviews to identify barriers and facilitators to optimal quality, and preoperative internet-based patient reviews. Hospital and regional cancer centre charts provide audit data for annual feedback reports to surgeons.
Participating surgeons at workshops and surgeon participants in preoperative reviews treated approximately 70 % of all LHIN4 patients undergoing colorectal surgery. For years 2006-2012, the rate of radiology imaging for colon and rectal cases increased from 70 to 91 % and from 71 to 91 %, respectively. For rectal cases, the rate of reporting radial margins increased (55-93 %), and the rate of positive radial margins decreased (14-6 %).
Initiation of the integrated knowledge translation QICC-L4 project in a large geographic region was associated with marked improvements in relevant colorectal cancer surgery quality markers.
利益相关者认为，将终端用户纳入质量改进干预措施的规划和执行中，可能更有效地缩小质量差距。我们在加拿大安大略省一个较大的地理区域（即 LHIN4）测试了这种方法是否可以提高结直肠癌手术的质量。
邀请所有在 LHIN4 提供结直肠癌手术的外科医生参加 2006 年 10 月的首届 QICC-L4 研讨会以及 2008 年、2010 年和 2012 年的后续研讨会。在研讨会上，外科医生选择了与临床相关的质量指标，以进行有针对性的改进，并采取干预措施以实现改进。选定的指标包括结肠和直肠影像学检查的比率、直肠放射状边缘距离的病理报告率以及直肠阳性放射状边缘的比率。迄今为止，实施的干预措施包括审计和反馈、量身定制访谈以确定实现最佳质量的障碍和促进因素，以及术前基于互联网的患者审查。医院和区域癌症中心的图表为外科医生提供年度反馈报告的审计数据。
在研讨会上参加的外科医生和参加术前审查的外科医生治疗了大约 70%在 LHIN4 接受结直肠癌手术的所有患者。在 2006 年至 2012 年期间，结肠和直肠病例的影像学检查率分别从 70%增加到 91%和从 71%增加到 91%。对于直肠病例，报告放射状边缘的比率增加（55%-93%），阳性放射状边缘的比率降低（14%-6%）。
在一个较大的地理区域启动综合知识转化 QICC-L4 项目与相关结直肠癌手术质量指标的显著改善有关。
