Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, Kapittelweg 54 (route 160), Nijmegen, The Netherlands.
PALGA Foundation, Houten, The Netherlands.
Implement Sci. 2022 Jul 30;17(1):52. doi: 10.1186/s13012-022-01224-5.
Implementation strategies are aimed at improving guideline adherence. Both effect and process evaluations are conducted to provide insights into the success or failure of these strategies. In our study, we evaluate the nationwide implementation of standardized structured reporting (SSR) in pathology.
An interrupted time series analysis was conducted to evaluate the effect of a previously developed implementation strategy, which consisted of various digitally available elements, on SSR in pathology laboratories. A segmented regression analysis was performed to analyze the change in mean SSR percentages directly after the strategy introduction for pathology reporting and specific subcategories. In addition, we analyzed the change in trend in the weekly percentages after strategy introduction, also for subgroups of tumor groups, retrieval methods, and type of laboratory. The change in SSR use after the strategy introduction was determined for all pathology laboratories. We further conducted a process evaluation in which the exposure to the strategy elements was determined. Experiences of the users with all strategy elements and the remaining barriers and potential strategy elements were evaluated through an eSurvey. We also tested whether exposure to a specific element and a combination of elements resulted in a higher uptake of SSR after strategy introduction.
There was a significant increase in an average use of SSR after the strategy introduction for reporting of gastrointestinal (p=.018) and urological (p=.003) oncological diagnoses. A significant increase was present for all oncological resections as a group (p=.007). Thirty-three out of 42 pathology laboratories increased SSR use after the strategy introduction. The "Feedback button", an option within the templates for SSR to provide feedback to the provider and one of the elements of the implementation strategy, was most frequently used by the SSR users, and effectiveness results showed that it increased average SSR use after the strategy introduction. Barriers were still present for SSR implementation.
Nationwide SSR implementation improved for specific tumor groups and retrieval methods. The next step will be to further improve the use of SSR and, simultaneously, to further develop potential benefits of high SSR use, focusing on re-using discrete pathology data. In this way, we can facilitate proper treatment decisions in oncology.
实施策略旨在提高指南的依从性。效果和过程评估都旨在深入了解这些策略的成败。在我们的研究中，我们评估了标准化结构化报告（SSR）在病理学中的全国性实施情况。
采用中断时间序列分析评估了先前开发的实施策略的效果，该策略由各种数字化可用元素组成，对病理学实验室的 SSR 产生了影响。进行分段回归分析，以分析策略引入后病理学报告和特定子类别中 SSR 的平均百分比变化。此外，我们还分析了策略引入后每周百分比变化的趋势，也包括肿瘤组、检索方法和实验室类型的亚组。确定了所有病理学实验室在策略引入后的 SSR 使用变化。我们进一步进行了过程评估，确定了对策略元素的暴露情况。通过电子调查评估了用户对所有策略元素的体验以及剩余的障碍和潜在的策略元素。我们还测试了暴露于特定元素和元素组合是否会导致策略引入后 SSR 的采用率更高。
策略引入后，胃肠道（p=.018）和泌尿系统（p=.003）肿瘤诊断报告的 SSR 平均使用率显著增加。所有肿瘤切除术的使用率均显著增加（p=.007）。在策略引入后，有 33 个病理学实验室增加了 SSR 的使用。SSR 模板中的“反馈按钮”是 SSR 的一个选项，用于向提供者提供反馈，也是实施策略的要素之一，是 SSR 用户最常使用的，效果结果表明，它增加了策略引入后的平均 SSR 使用率。SSR 实施仍存在障碍。
特定肿瘤组和检索方法的全国性 SSR 实施得到了改善。下一步将进一步提高 SSR 的使用率，同时进一步开发 SSR 高使用率的潜在优势，重点是重新使用离散的病理学数据。通过这种方式，我们可以促进肿瘤学中的适当治疗决策。
