Assurance de qualité pour le cancer rectal – phase 2 ...

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70 PROCARE – phase 2 KCE reports 81Table 58. Overview of suggested actions per QI.QI Suggested actions1111 • Continue follow-up (at least 5 years)• Take into account postoperative mortality (through link with administrative database)1112 • Use relative 5-year survival as proxy• Continue follow-up (at least 5 years)1113 • Continue follow-up (at least 5 years)• Remove default ‘0’ value in PROCARE database• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)• Reduce number of missing data (type of resection, (y)pStage)• Risk-adjustment: e.g. tumour level, stage1114 • Link PROCARE database to administrative databases• Reconsider relevance of this indicator1211 • Data cleaning necessary1212 • Adapt PROCARE variable in data entry set to render QI measurable1213 • Consider measuring the QI for all patients1214 • Adapt PROCARE data entry set• Consider measuring the QI for all patients1215 • Risk-adjustment: tumour level, tumour stenosis• Consider measuring the QI for all patients1216 • Reduce number of missing data (cStage)1217 • Reduce number of missing data (date of biopsy)• Consider redefining the QI (time between first consultation and first treatment)1221 • Reduce number of missing data (cStage, radiotherapy regimen)• Add PROCARE variable asking for prescribed radiotherapy regimen• Risk-adjustment: e.g. tumour level, age, comorbidities• Consider measuring the QI for all cStage II-III patients1222 • Reduce number of missing data (cStage, radiotherapy regimen)• Add PROCARE variable asking for prescribed radiotherapy regimen• Risk-adjustment: e.g. tumour level, age, comorbidities• Consider measuring the QI for all cStage II-III patients1223 • Reduce number of missing data (cStage, chemotherapy regimen)• Consider measuring the QI for all cStage II-III patients1224 • Add PROCARE variable to render QI measurable• Consider measuring the QI for all cStage II-III patients1225 • Remove default ‘0’ value in PROCARE database• Reduce number of missing data (cStage, radiotherapy regimen)• Consider measuring the QI for all cStage II-III patients1226 • Reduce number of missing data (cStage, radiotherapy regimen)1227 • Add PROCARE variable to render QI measurable1231 • Reduce number of missing data (cStage)• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)• Risk-adjustment: stage, cCRM1232a • Risk-adjustment: e.g. tumour level1232b • Adapt PROCARE variable to render QI measurable for the PROCARE database• Risk-adjustment: tumour level, comorbidities, stage1233 • Reduce number of missing data (type of surgery)• Risk-adjustment: tumour level, type of resection, presence of stoma1234 • Risk-adjustment: age, stage, comorbidities (expected/observed ratio)1235 • Remove default ‘0’ value in PROCARE database• Risk-adjustment: tumour level (including dorsal – ventral), stage1241 • Reduce number of missing data (adjuvant treatment, (y)pStage)
KCE Reports 81 PROCARE – phase 2 71QI Suggested actions• Adapt PROCARE data entry form on adjuvant treatment• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)• Risk-adjustment: age, comorbidities, postoperative morbidity1242 • Reduce number of missing data (adjuvant treatment)• Adapt PROCARE data entry form on adjuvant treatment• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)• Risk-adjustment: age, comorbidities, postoperative morbidity1243 • Reduce number of missing data (adjuvant treatment, (y)pStage)• Adapt PROCARE data entry form on adjuvant treatment• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)• Risk-adjustment: age, comorbidities, postoperative morbidity1244 • Reduce number of missing data (adjuvant treatment, (y)pStage)• Adapt PROCARE data entry form on adjuvant treatment• Use real R0 proportion (taking into account pathology results and absence ofintraoperative rectal perforation)1245 • Reduce number of missing data (adjuvant treatment, (y)pStage)• Remove default ‘0’ value in PROCARE database• Adapt PROCARE data entry form on adjuvant treatment1251 • Reduce number of missing data (cStage)• Risk-adjustment: age, comorbidities• Use ‘corrected cStage’ taking into account peroperative findings of metastasis1252 • Reduce number of missing data (cStage)• Remove default ‘0’ value in PROCARE database1261 • Add PROCARE variable to render QI measurable1262 • Add PROCARE variable to render QI measurable1263 • Longer follow-up necessary• Remove default ‘0’ value in PROCARE database1271 • Add PROCARE variable to render QI measurable1272 • Risk-adjustment: tumour level, stage1273 • Risk-adjustment: tumour level1274 • Risk-adjustment: neoadjuvant treatment, (y)pN1275 • Reduce missing data (pathology data)1276 • Reduce missing data (neoadjuvant treatment)• Risk-adjustment: neoadjuvant treatment3.3.4 Complementarity of both databasesWorking with prospectively collected data clearly has some important advantages. Theavailability of clinical data is of major importance for the evaluation of the quality ofcare. This is probably the most important reason for the difference in measurability ofthe QI between both databases. Although the collection of the PROCARE data startedabout 1,5 years before the start of the present study (i.e. without having a clear ideaabout which QI to measure), already 75% of the selected QI is measurable using thesedata. Based on the present exercise, the prospective data collection can be renderedeven more specific.Another advantage is the quality control of the data collection. Data managers cancontact the responsible clinicians in case of missing data or inconsistencies. At the sametime, this is a major disadvantage of prospective databases. Data collection, data cleaningand chasing missing data is expensive and time-consuming. At present, the PROCAREdata collection is done manually. Ideally, a system is used where data can be collectedelectronically (this is planned in the near future). However, for the involved cliniciansprospective data collection still remains a burden.
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KCE Reports 81B Cancer rectal - pha
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vi Cancer rectal - phase 2 KCE Repo
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2 PROCARE - phase 2 KCE reports 81A
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Dépôt légal : D/2008/10.273/39
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35. Etude relative aux coûts poten
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