부산대학교 도서관

Background Patients requiring assessment for cancer surgery encounter a complex series of steps in their cancer journey. Further complicating the process is the fact that care is often delivered in a fragmented, silo-based system. Isolated strategies to improve cancer outcomes within those systems have had inconsistent results. Methods A regional quality improvement collaborative was developed based on a community of practice (cop) platform, a hub-and-spoke infrastructure, and a regional steering committee linking COP improvement projects with affiliated hospitals and their strategic priorities. The COP provided an avenue for multidisciplinary teams to collect and compare their performance data and to institute regional standards through literature review, discussion, and consensus. Regional interdisciplinary teams developed a set of quality indicators linked to mutually agreed-upon care standards. A limited regional database sup- ported feedback about performance against both provincial and regional standards. Results The COP approach helped to develop a multihospital collaboration that facilitated care quality improve- ments on a regional scale, with clinical outcomes of the improvements able to be measured. The 9 participat- ing hospitals delivered cancer surgery in the specific disease sites according to practitioner-developed and provincially- or regionally-generated care standards and clinical pathways. Compliance with provincial evidence-based clinical guidelines improved (20% increase in 2010-2011 compared with 2006-2007). Other significant improvements included standardization and implementation of regional perioperative pathways in breast, colorectal, and prostate cancer disease sites; rectal cancer surgery centralization; increased use of sentinel lymph node biopsies in breast cancer surgery; and decreased positive surgical margin rates in prostate cancer. Conclusions Improved quality is likely a result of diverse confounding factors. The deliberately cultivated multihospital multidisciplinary cons have contributed to positive structural and functional change in cancer surgery in the region. This regional COP model has the potential to play an important role in the development of successful collaborations in care quality improvement. [ABSTRACT FROM AUTHOR]