TY - JOUR
T1 - National Improvement of Waiting Times
T2 - First Results From the Dutch Head and Neck Audit
AU - van Oorschot, Hanneke Doremiek
AU - de Jel, Dominique Valérie Clarence
AU - Hardillo, Jose Angelito
AU - Smeele, Ludi E.
AU - Baatenburg de Jong, Robert Jan
N1 - Funding Information: We thank all members of the Dutch head and neck audit group for contributing. The authors thank all registrars, physician assistants, and administrative nurses who registered patients in the DHNA. This work was supported by the Department of Otorhinolaryngology and Head and Neck Surgery of the Erasmus Medical Centre Cancer Institute (Rotterdam, the Netherlands). Publisher Copyright: © 2023 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.
PY - 2023
Y1 - 2023
N2 - Objective: 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. Study Design: Prospective cohort study. Setting: National multicentre study. Methods: 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%. Results: 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. Conclusion: 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.
AB - Objective: 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. Study Design: Prospective cohort study. Setting: National multicentre study. Methods: 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%. Results: 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. Conclusion: 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.
KW - diagnostic delay
KW - head and neck cancer
KW - hospital variation
KW - quality registry
KW - survival
KW - therapeutic delay
KW - time interval
UR - http://www.scopus.com/inward/record.url?scp=85173034410&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ohn.532
DO - https://doi.org/10.1002/ohn.532
M3 - Article
C2 - 37747035
SN - 0194-5998
JO - Otolaryngology-Head and Neck Surgery
JF - Otolaryngology-Head and Neck Surgery
ER -