دورية أكاديمية
أعرض في EDS

Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level.

التفاصيل البيبلوغرافية
العنوان: Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level.
المؤلفون: Vink MD; Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands.; Department of Obstetrics and Gynecology, Isala, Zwolle, the Netherlands., Hofstra G; Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands., Koolman X; Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands., Bekkers RL; Department of Obstetrics and Gynecology, Catherina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.; Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands., Siebers AG; PALGA, Houten, 3991SZ, the Netherlands., van Kemenade FJ; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, the Netherlands., Böcker KB; National Health Care Institute, Diemen, 1112 ZA, the Netherlands., Ten Hove M; Vektis, Zeist, 3708 JE, the Netherlands., van der Hijden EJ; Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands.; Zilveren Kruis Health Insurance, Leusden, the Netherlands.
المصدر: Preventive medicine reports [Prev Med Rep] 2023 Feb 10; Vol. 32, pp. 102134. Date of Electronic Publication: 2023 Feb 10 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101643766 Publication Model: eCollection Cited Medium: Print ISSN: 2211-3355 (Print) Linking ISSN: 22113355 NLM ISO Abbreviation: Prev Med Rep Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: [New York, NY] : Elsevier Inc., [2014]-
مستخلص: Research into the quality of cancer screening programs often lacks the perspective of clinicians, missing insights into the performance of individual hospitals. This retrospective cohort study aimed to identify guideline deviation (specifically, overtreatment and undertreatment) related to the cervical cancer screening program in Dutch hospitals by deterministically linking nationwide insurance data with pathology data for cervical intraepithelial neoplasia (CIN). We then constructed quality indicators using the Dutch CIN guideline and National Health Care Institute recommendations to assess compliance with CIN management, treatment outcomes, and follow-up, using an empirical Bayes shrinkage model to correct for case-mix variation and hospitals with few observations. Data were linked for 115,899 of 125,751 (92%) eligible women. Overtreatment was observed in the see-and-treat approach (immediate treatment) for women with low-grade referral cytology (4%; hospital range, 0%-25%), CIN ≤ 1 treatment specimens (26%; hospital range, 10%-55%), and follow-up cervix cytology ≥2 months before the guideline recommendation after treatment for CIN 2 (2%; hospital range, 0%-9%) or CIN 3 (5%; hospital range, 0%-19%). By contrast, undertreatment was observed for treatment within 3 months after a CIN 3 biopsy result (90%; hospital range 59%-100%) and follow-up ≥2 months beyond the guideline recommendation after treatments for CIN 2 (21%, hospital range 7%-48%) and CIN 3 (20%, hospital range 7%-90%). In conclusion, we found evidence of CIN overtreatment and undertreatment in all measured domains at the hospital level. Guideline adherence could be improved by implementing the developed indicators in an audit and feedback instrument for use by healthcare professionals in routine practice.
Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(© 2023 The Author(s).)
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فهرسة مساهمة: Keywords: CIN, cervical intraepithelial neoplasia; Cervical cancer screening; Cervical intraepithelial neoplasia; Guideline adherence; Health policy; LEEP, loop electrosurgical excision procedure; National screening program; Physician practice patterns; Quality indicators; hrHPV, high-risk human papillomavirus
تواريخ الأحداث: Date Created: 20230228 Latest Revision: 20230301
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC9958351
DOI: 10.1016/j.pmedr.2023.102134
PMID: 36852310
قاعدة البيانات: MEDLINE
الوصف
تدمد:2211-3355
DOI:10.1016/j.pmedr.2023.102134