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

80 PROCARE – phase 2 KCE reports 815 CONCLUSIONSThe ultimate aim of PROCARE is to decrease diagnostic and therapeutic variabilitybetween centres and to improve the quality of care for all patients presenting withrectal cancer. The identification of teams with suboptimal performance is a delicatematter and requires well-developed quality indicators, high-quality data (with adequateapplication of definitions), and adjustment for risk factors. The combination of aliterature search and expert opinion made it possible to construct a set of 40 relevantQI for rectal cancer. For most selected QI, all necessary elements to be measurable areavailable in the PROCARE database and/or administrative databases. However, based onthe results of the present study, a refinement of some QI and of the PROCARE dataentry form is necessary. Also, in order to minimise the number of missing data and toincrease the performance of the PROCARE data registration and analysis, a webapplication for data submission should be developed. Training of datamanagers isessential for an efficient and correct collection of patient data.The present study shows that a linkage between the BCR database and otheradministrative databases is feasible and highly accurate (at least for the linkage betweenthe BCR and HIC databases). The BCR data were shown to be exploitable and relevantfor at least part of the selected quality indicators. Apart from the administrative BCRdata, the BCR has also proved to have the necessary capacity for prospective dataregistration and analysis. Therefore, the BCR is an essential partner for future similarprojects.Using the administrative databases, some relevant QI were measurable. However, thetotal number of measurable QI was rather low. Of these, the outcome indicators onsurvival and mortality, measurable with data coming from the Sickness Funds, canprobably be considered the most meaningful. For this project, the contribution of theMCD-MFD database was limited.The PROCARE project is a pilot project for Belgium. So far, many centres involved inthe PROCARE project only included a low number of patients, making an interpretationof most QI difficult at present. Nevertheless, the involved centres expect a firstindividual feedback very soon. Therefore, it should be considered to give this feedbackwithout further interpretation until the end of 2009. By then, the total amount ofincluded patients can be expected to exceed 2500. At that time, the relevance andinterpretability of the QI should be reassessed, e.g. by comparing the PROCARE data tothe administrative data for the same time period and by performing risk-adjustmentwhere necessary. At a later stage, it can also be considered to pool the results of thesmaller centres (i.e. with 5 or less patients per year), and to provide these pooledresults in addition to the individual feedback.In view of the needed refinements and difficult interpretation of the QI at present, itshould be stressed again that the preliminary QI results presented in this report cannotbe used to judge the quality of rectal cancer care. Indeed, given the relatively lownumber of included patients per PROCARE centre, this study seems to be done toosoon to draw firm conclusions. Ideally, this exercise was piloted with a much morefrequent cancer, such as breast cancer.The prospective PROCARE registration is on a voluntary basis, and to increase theownership of the project, this voluntarism should be encouraged. Registration burden isan important threat for this project, and it is therefore recommended to revise thecurrent data entry form, which is very exhaustive at present. By providing the individualfeedback in an attractive, professional and comprehensible lay-out, additional centrescan be convinced to join the project.In the long run, the coverage of the PROCARE registration needs to be improved andassured, e.g. by providing incentives or by checking the coverage through linkage withadministrative databases. Indeed, as complete as possible coverage is essential to allow ameaningful population-based international benchmarking. The present study has shownthe potential for such an international exercise. However, it is recommended to await ahigher amount of included patients.