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The impact of centralization of services on treatment delay in ovarian cancer: A study on process quality

Objective
Emphasis on improving healthcare quality has led to centralization of services for patients suspected of ovarian cancer. As centralization of services may induce treatment delays, we aimed to assess compliance with health system interval guidelines in patients suspected of ovarian cancer.


Design
Evaluation of health system intervals, comparison between direct and indirect referrals and between 2013 and 2014.


Setting
A managed clinical network (MCN) comprising 11 hospitals in the Netherlands.


Participants
Patients that were treated for ovarian cancer within the University Medical Center Groningen in 2013 and 2014.


Intervention
Introduction of an MCN to centralize services for patients suspected of ovarian cancer.


Main Outcome Measure
Compliance with national guidelines regarding health system intervals.


Results
Between 2013 and 2014 a clinically relevant improvement in compliance with guidelines was demonstrated. Within this period, median treatment intervals decreased from 34 to 29 days, and the percentage of patients in which treatment interval guidelines were met increased from 63.5 to 72.2%. New regulations and increased awareness of health system intervals inspired changes in local practice leading to improved compliance with guidelines. Compliance was highest in patients that were directly referred to our academic hospital.


Conclusion
Evaluation of health system intervals in patients suspected of ovarian cancer was feasible and may be applicable to other MCNs. Though compliance with guidelines improved within the study period, there is potential for improvement. To facilitate real-time evaluation of compliance with national guidelines establishing uniformity of electronic patient files in the MCN is deemed essential.