Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level
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 cervi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | Preventive Medicine Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211335523000256 |
| _version_ | 1797867395093626880 |
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| author | Maarten D. Vink Geeske Hofstra Xander Koolman Ruud L. Bekkers Albert G. Siebers Folkert J. van Kemenade Koen B. Böcker Michiel ten Hove Eric J. van der Hijden |
| author_facet | Maarten D. Vink Geeske Hofstra Xander Koolman Ruud L. Bekkers Albert G. Siebers Folkert J. van Kemenade Koen B. Böcker Michiel ten Hove Eric J. van der Hijden |
| author_sort | Maarten D. Vink |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T23:40:36Z |
| format | Article |
| id | doaj.art-822cc820135a413798ac732224f4be91 |
| institution | Directory Open Access Journal |
| issn | 2211-3355 |
| language | English |
| last_indexed | 2024-04-09T23:40:36Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Preventive Medicine Reports |
| spelling | doaj.art-822cc820135a413798ac732224f4be912023-03-19T04:37:31ZengElsevierPreventive Medicine Reports2211-33552023-04-0132102134Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital levelMaarten D. Vink0Geeske Hofstra1Xander Koolman2Ruud L. Bekkers3Albert G. Siebers4Folkert J. van Kemenade5Koen B. Böcker6Michiel ten Hove7Eric J. van der Hijden8Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Isala, Zwolle, the Netherlands; Corresponding author at: Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands.Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the NetherlandsDepartment of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the NetherlandsDepartment 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 NetherlandsPALGA, Houten, 3991SZ, the NetherlandsDepartment of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, the NetherlandsNational Health Care Institute, Diemen, 1112 ZA, the NetherlandsVektis, Zeist, 3708 JE, the NetherlandsDepartment of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, the Netherlands; Zilveren Kruis Health Insurance, Leusden, the NetherlandsResearch 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.http://www.sciencedirect.com/science/article/pii/S2211335523000256Cervical intraepithelial neoplasiaQuality indicatorsGuideline adherenceCervical cancer screeningNational screening programHealth policy |
| spellingShingle | Maarten D. Vink Geeske Hofstra Xander Koolman Ruud L. Bekkers Albert G. Siebers Folkert J. van Kemenade Koen B. Böcker Michiel ten Hove Eric J. van der Hijden Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level Preventive Medicine Reports Cervical intraepithelial neoplasia Quality indicators Guideline adherence Cervical cancer screening National screening program Health policy |
| title | Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level |
| title_full | Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level |
| title_fullStr | Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level |
| title_full_unstemmed | Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level |
| title_short | Identification of over- and undertreatment in the Dutch national cervical cancer screening program: A data linkage study at the hospital level |
| title_sort | identification of over and undertreatment in the dutch national cervical cancer screening program a data linkage study at the hospital level |
| topic | Cervical intraepithelial neoplasia Quality indicators Guideline adherence Cervical cancer screening National screening program Health policy |
| url | http://www.sciencedirect.com/science/article/pii/S2211335523000256 |
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