Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands.
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands.
Otolaryngol Head Neck Surg. 2024 Mar;170(3):766-775. doi: 10.1002/ohn.532. Epub 2023 Sep 25.
Timely treatment initiation in head and neck cancer (HNC) care is of great importance regarding survival, oncological, functional, and psychological outcomes. Therefore, waiting times are assessed in the Dutch Head and Neck Audit (DHNA). This audit aims to assess and improve the quality of care through feedback and benchmarking. For this study, we examined how waiting times evolved since the start of the DHNA.
Prospective cohort study.
National multicentre study.
The DHNA was established in 2014 and reached national coverage of all patients treated for primary HNC in 2019. DHNA data on curative patients from 2015 to 2021 was extracted on national (benchmark) and hospital level. We determined 3 measures for waiting time: (1) the care pathway interval (CPI, first visit to start treatment), (2) the time to treatment interval (TTI, biopsy to start treatment), and (3) CPI-/TTI-indicators (percentage of patients starting treatment ≤30 days). The Dutch national quality norm for the CPI-indicator is 80%.
The benchmark median CPI and TTI improved between 2015 and 2021 from 37 to 26 days and 37 to 33 days, respectively. Correspondingly, the CPI- and TTI-indicators, respectively, increased from 39% to 64% and 35% to 40% in 2015 to 2021. Outcomes for all hospitals improved and dispersion between hospitals declined. Four hospitals exceeded the 80% quality norm in 2021.
Waiting times improved gradually over time, with 4 hospitals exceeding the quality standard in 2021. On the hospital-level, process improvement plans have been initiated. Systematic registration, auditing, and feedback of data support the improvement of quality of care.
头颈部癌症（HNC）治疗的及时启动对生存、肿瘤学、功能和心理结果都非常重要。因此，荷兰头颈部审计（DHNA）评估了等待时间。该审计旨在通过反馈和基准测试来评估和改善护理质量。在这项研究中，我们研究了自 DHNA 开始以来等待时间的变化情况。
前瞻性队列研究。
全国多中心研究。
DHNA 成立于 2014 年，并于 2019 年实现了对所有接受原发性 HNC 治疗患者的全国覆盖。从 2015 年至 2021 年，DHNA 提取了全国（基准）和医院层面的治愈患者数据。我们确定了 3 个等待时间指标：（1）治疗路径间隔（CPI，首次就诊至开始治疗），（2）治疗时间间隔（TTI，活检至开始治疗），以及（3）CPI-/TTI 指标（≤30 天开始治疗的患者百分比）。荷兰 CPI 指标的国家质量标准为 80%。
2015 年至 2021 年，基准中位数 CPI 和 TTI 分别从 37 天改善至 26 天和 37 天改善至 33 天。相应地，CPI-和 TTI 指标分别从 2015 年的 39%增加至 64%和 35%增加至 40%至 2021 年。所有医院的结果都有所改善，医院之间的差异也有所缩小。2021 年有 4 家医院超过了 80%的质量标准。
随着时间的推移，等待时间逐渐改善，2021 年有 4 家医院超过了质量标准。在医院层面，已经启动了流程改进计划。数据的系统登记、审计和反馈支持了护理质量的改善。
