title: Improved guideline compliance after a 3-year audit of multidisciplinary colorectal cancer care in the western part of the Netherlands.
abstract: BACKGROUND
  From 2006 to 2008, an audit of the multidisciplinary diagnosis and treatment of colorectal cancer patients in the western part of the Netherlands was carried out. We evaluated whether compliance with guidelines had improved.
  
  
  METHODS
  All patients with newly diagnosed and surgically treated colon (n = 1,667) and rectal cancer (n = 544) stage I-III were evaluated. Nine quality indicators were derived from the evidence-based guidelines. In order to compare hospital performances, hospital results were adjusted for casemix differences between hospitals.
  
  
  RESULTS
  Colon cancer patients showed an increase in the examination of 10 or more lymph nodes (from 53% to 78%, P < 0.0001). For rectal cancer patients there was an increase in preoperative visualisation of the total colon (63-74%, P = 0.02), MRI (73-85%, P = 0.003), radiotherapy (from 82% to 93% for patients <75 years, P = 0.01) and examination of at least 10 lymph nodes (40-55%, P = 0.004). In 2006, standardised hospital performances differed widely for all quality indicators. Two years later, hospital performances for some quality indicators were more similar.
  
  
  CONCLUSIONS
  After the feedback of benchmark information, compliance with guidelines for diagnosis and treatment of colorectal cancer patients improved, and differences between individual hospitals decreased. Although secular trends cannot be ruled out, it is highly likely that these results can be attributed to the audit.
authors.affiliation: Comprehensive Cancer Centre the Netherlands (CCCNL), Utrecht, The Netherlands. L.vanderGeest@iknl.nl
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: Pieta
authors.initials: P
authors.lastname: Krijnen
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Willemien G W
authors.initials: WG
authors.lastname: Erkelens
authors.forename: Andreas W K S
authors.initials: AW
authors.lastname: Marinelli
authors.forename: Hans J W R
authors.initials: HJ
authors.lastname: Nortier
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: Henk
authors.initials: H
authors.lastname: Struikmans
mesh_terms: D000368:Aged; D019985:Benchmarking; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D003953:Diagnosis-Related Groups; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009426:Netherlands; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D013997:Time Factors