Background and aims: in 2006 the High Risk of Colorectal Cancer Clinic (HRCC) was set up in the Hospital Clinic of Barcelona consisting in a new organizational model/program for the prevention of colorectal cancer (CRC) in high risk population. The main activities of this program focus on: a) identifying individuals and/or patients with an increased risk of developing CRC; b) establishing the CRC risk based on personal and hereditary risk factors, c) propose the most adequate strategies of screening and/or surveillance, d) offering genetic counseling and testing in the hereditary types of CRC and also psychological support for shared decisionmaking of users and clinicians and e) define other preventive, diagnostic and therapeutic strategies. A conceptual model and indicators were developed in a previous study based on an evaluative approach (structure, process and outcome), domains of quality of care and activities of the HRCC. The aim of this study was to implement a set of indicators to assess quality of care at baseline and external level of this new organizational model. Methodology: a retrospective observational study was carried out, and 21 quality indicators were implemented. The study population consisted of all users with a higher risk of colorectal cancer attended in the program between the 1st of January 2006 and the 12th of May 2010 (advanced colorectal adenoma, polyposic syndrome, colorectal cancer or a family history of CRC). Information was obtained from electronic medical records, observation of clinical and management documentation and a survey sent to professionals by e-mail. For each indicator, a formula was computed and compliance with a previously agreed quality standard was described. Comparison of proportions and logistic regression models were computed to analyze demographic and health variables associated with adherence to colonoscopies in the program, computing odds ratio and 95% confidence intervals (CI). Results: a total of 1,275 users were included in this study. Some of the structure and process indicators that reached the level of compliance with the healthcare quality standards were the availability of electronic medical records and the existence of a quality program for colonoscopies (100 %). Forty-three percent of users were referred from primary care and 28.5% from inpatient services to the program (coordinated from the gastroenterology service). The rate of referral of users with an indication of molecular genetic test to the psychology service in the program was relatively low (1.6%). The level of adherence of users to surveillance endoscopic strategies was 91%, while overall adherence was 67% (screening and surveillance). Users over 59 years had almost 2 times more probability (confidence interval95%, CI95%: 1.3 to 3.1) to be attached to the program than younger users; while users with surveillance colonoscopies presented 7.4 times (CI95%: 4.6 to 11.7) more probability of adherence than those who performed screening colonoscopies. Conclusions: this study has evaluated the quality of care of the HRCC, carried out by the Agency of Health Information, Assessment and Quality. This is one of the first initiatives in Catalonia and the Spanish National Health System in general, to externally evaluate the quality of healthcare of a preventive program of CRC in high risk population. The indicators have shown their usefulness, feasibility and validity to identify areas for improvement of this new organizational model, such as information systems, continuity of care and communication among professionals in the program. The fact there are no published quality standards for each indicator, makes the study an innovative assessment, but means that further evaluation is necessary in a time in the HRCC or the implementation of these indicators in other programs or centers to facilitate the interpretation of results of the indicators and standards of quality
Colorectal cancer prevention program; Evaluation; Health Indicators
Serra-Sutton V, Barrantes-Serrano C, Espallargues-Carreras M. Implementació d’indicadors per avaluar la clínica d’alt risc de càncer colorectal. Barcelona: Agència d’Informació, Avaluació i Qualitat en Salut; 2011.
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