We are in the fourth year of a national audit looking at the quality of bowel cancer care in the UK.
Describe your project.
We are in the fourth year of a national audit looking at the quality of bowel cancer care in the UK. The main organisations involved are Imperial College London, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Healthcare Commission. It’s a very important project, probably the biggest in the UK in this field.
What are your objectives?
We want to improve the way clinicians deliver care for patients who suffer from this disease and undergo surgery - that’s around 30,000 people each year in the UK. We are investigating how individual patients can improve their chances of surviving an operation and how hospitals and clinicians themselves can improve the quality of care they provide.
What has been happening so far?
We have been collecting information from 106 hospitals. That’s around 40 per cent of the UK total. Data is collected locally, as part of normal clinical practice, by multidisciplinary team coordinators. It is then sent to us for central analysis. It is by measuring outcomes in different hospitals and feeding information back to them that we can improve the quality of care. We will identify common risk factors that can be tackled by each hospital. We also want to be able to compare one unit with another unit. This information will also be useful to patients.
What outcome measures are you investigating and what have you discovered?
We are examining things like mortality and length of hospital stay. We are also looking at how many lymph glands are harvested as a proxy for the quality of the surgery. On mortality for colorectal disease, we know there is little variation between hospitals. However, in terms of the quality of surgery and pathology recording, there is a significant difference.
What needs to happen next?
We need to identify the hospitals that have better outcomes than others, identify their processes and then produce guidelines for improvements across the board that will ensure all patients receive the best care. We still have to analyse more data, and hope to have 80 per cent of UK hospitals involved in a year’s time. Our grant from the Health Foundation enables us to do this and develop the quality of the data over a longer period.
What are the challenges you face?
We’re not yet in a position where we can change practice in individual hospitals, although we are producing scientific papers on a regular basis. The challenge is to obtain complete data and disseminate it properly. If we disclose information too early, when the data quality isn’t adequate, it could cause harm, rather than good, and increase anxiety among patients. We have been consulting with patient representatives. It’s important to know what information to disclose and when.
In this year’s annual report, we named the hospitals which have taken part in the audit for the first time. But we’re not yet able to give information about individual surgeons’ practice. We have been interacting with other groups who are interested in the national audit and learning from other people’s experience. With support from the Health Foundation we’ve been able to solve some issues about confidentiality and the management of the project generally.
04 January 2006