Quality Indicators to Assess a Colorectal Cancer Prevention Program

OBJECTIVES The aim of this study was to implement a set of indicators to assess the quality of care of a new healthcare model for prevention of colorectal cancer in a high-risk population. METHODS Information was obtained retrospectively from electronic clinical records, review of documentation, and a survey. The high-risk clinic for colorectal cancer was created in Barcelona (Spain) in 2006. All users at greater risk of colorectal cancer assessed through the new healthcare model were included. Twenty-one indicators were computed using defined formulas and standards. Logistic regression models were computed to analyze factors related to adherence to the screening and surveillance prevention strategies. RESULTS A total of 1,275 users were included. Eight of seventeen indicators reached the quality standard (80 percent structure, 50 percent process, and 17 percent outcome), whereas four indicators did not have a previously defined standard. The overall adherence to the screening and surveillance program was 67 percent. Users aged 59 and older had almost two times greater probabiblity (95 percent confidence interval [CI], 1.3-3.1) of adherence than younger users; users with surveillance colonoscopies presented a 7.4 times (95 percent CI, 4.6-11.7) greater probability of adherence than those with screening colonoscopies. CONCLUSIONS The indicators have been shown to be feasible and valid tools to identify areas of improvement in this new model, such as information systems, continuity of care, and communication among professionals. Because this was the first time these indicators were applied to assess the high-risk clinic for colorectal cancer, further implementation is required to improve the interpretability of results.