title: Province wide clinical governance network for clinical audit for quality improvement in endometrial cancer management.
abstract: BACKGROUND
  According to the hub-and-spoke model introduced in the Provincial Healthcare System of Reggio Emilia, early endometrial cancer is treated in peripheral low-volume hospitals (spokes) by general gynecologist, whereas more complex cancers are treated by gynecological oncologists at the main hospital (hub).
  
  
  OBJECTIVE
  To guarantee a uniformly high standard of care to all patients with endometrial cancer treated in hub and spoke hospitals of Reggio Emilia Province.
  
  
  METHODS
  The specialists of the 5 hospitals of Reggio Emilia Province instituted an inter hospital and multidisciplinary oncology group to write common and shared guidelines based on evidence-based medicine through the use of clinical audit. They valued the process indicators before and after guidelines introduction identifying the site of improvement and verifying the standard achievement.
  
  
  RESULTS
  Diagnostic hysteroscopy use increased significantly from preguideline period, 53%, to postguideline period, 74%. Magnetic resonance use and accuracy increased significantly from preguideline to postguideline periods: 8.1% to 35.3% and 37.3% to 74.7%, respectively. Laparoscopy use increased from 1.6% (preguideline) to 18.6 (postguideline). Early surgical complications decreased from 16% (preguideline) to 9% (postguideline). Radiotherapy use increased from 14.% (preguideline) to 32.3% (postguideline).
  
  
  CONCLUSIONS
  It is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.
authors.affiliation: Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova, University of Modena and Reggio Emilia, Italy. VincenzoDario.Mandato@asmn.re.it
authors.forename: Vincenzo Dario
authors.initials: VD
authors.lastname: Mandato
authors.forename: Debora
authors.initials: D
authors.lastname: Formisano
authors.forename: Debora
authors.initials: D
authors.lastname: Pirillo
authors.forename: Gino
authors.initials: G
authors.lastname: Ciarlini
authors.forename: Lillo Bruno
authors.initials: LB
authors.lastname: Cerami
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ventura
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spreafico
authors.forename: Tamara
authors.initials: T
authors.lastname: Palmieri
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: La Sala
authors.forename: Martino
authors.initials: M
authors.lastname: Abrate
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000628:therapy; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D007558:Italy; D008485:Medical Audit; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000458:organization & administration / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies