L'impatto delle Forze Operative Nazionali sulla qualità dell'assistenza di alcune neoplasie: risultati ed implicazioni di uno studio sulla resa di un intervento educativo.

Translated title of the contribution: Impact of the National Task Force on the quality of assistance to neoplasm patients: results and implications of a study on implementation of educational intervention

R. Grilli, G. Apolone, A. Liberati, A. Nicolucci

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Over the last ten years the Italian National Research Council (CNR) has launched an educational program aimed at facilitating the delivery of the most up to date care to cancer patients in community hospitals. Management guidelines were developed for breast, colo-rectal and ovarian cancer by multidisciplinary teams of national experts reported in booklets distributed nationwide under the aegis of disease oriented Task Forces. Some of them in addition endorsed other educational activities and sponsored multicenter trials. In 1988, the CNR funded a study to assess the impact of the whole effort. In particular the evaluation program was designed to see whether: a) the guidelines had a large diffusion in the target physicians' population; b) their content was accepted by those exposed to them and, c) practice patterns were consistent with the guidelines' recommendations. The above mentioned end-points were investigated through physicians' surveys and patterns of care studies carried out in a nationwide sample of 45 community hospitals and, on the whole, involving 1874 doctors (response rate was 41%) and 1483 patients with one of the three cancers. Results indicate a very limited impact of the program. Awareness of the guidelines was unsatisfactorily low (65%, 47% and 48% for breast, colo-rectal and ovarian cancer, respectively) and seemed to be more related to individual physicians' interest than to the functioning of the program. Analysis of practice patterns showed serious deficiencies even in centers where a more widespread awareness of the guidelines might have been expected to result in a better quality of care. We conclude that any assessment of interventions based on diffusion of information must include careful analysis of the process of diffusion itself and that the availability of clinically relevant messages must also be realistically considered before deciding whether the "guidelines approach" is the strategy most likely to succeed.

Original languageItalian
Pages (from-to)50-61
Number of pages12
JournalEpidemiologia e prevenzione
Volume12
Issue number42
Publication statusPublished - Mar 1990

Fingerprint

Advisory Committees
Guidelines
Neoplasms
Community Hospital
Rectal Neoplasms
Physicians
Ovarian Neoplasms
Breast
Pamphlets
Quality of Health Care
Health Services Needs and Demand
Program Evaluation
Multicenter Studies
Education

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "L'impatto delle Forze Operative Nazionali sulla qualit{\`a} dell'assistenza di alcune neoplasie: risultati ed implicazioni di uno studio sulla resa di un intervento educativo.",
abstract = "Over the last ten years the Italian National Research Council (CNR) has launched an educational program aimed at facilitating the delivery of the most up to date care to cancer patients in community hospitals. Management guidelines were developed for breast, colo-rectal and ovarian cancer by multidisciplinary teams of national experts reported in booklets distributed nationwide under the aegis of disease oriented Task Forces. Some of them in addition endorsed other educational activities and sponsored multicenter trials. In 1988, the CNR funded a study to assess the impact of the whole effort. In particular the evaluation program was designed to see whether: a) the guidelines had a large diffusion in the target physicians' population; b) their content was accepted by those exposed to them and, c) practice patterns were consistent with the guidelines' recommendations. The above mentioned end-points were investigated through physicians' surveys and patterns of care studies carried out in a nationwide sample of 45 community hospitals and, on the whole, involving 1874 doctors (response rate was 41{\%}) and 1483 patients with one of the three cancers. Results indicate a very limited impact of the program. Awareness of the guidelines was unsatisfactorily low (65{\%}, 47{\%} and 48{\%} for breast, colo-rectal and ovarian cancer, respectively) and seemed to be more related to individual physicians' interest than to the functioning of the program. Analysis of practice patterns showed serious deficiencies even in centers where a more widespread awareness of the guidelines might have been expected to result in a better quality of care. We conclude that any assessment of interventions based on diffusion of information must include careful analysis of the process of diffusion itself and that the availability of clinically relevant messages must also be realistically considered before deciding whether the {"}guidelines approach{"} is the strategy most likely to succeed.",
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