title: Long-term effects of a regional care pathway for patients with rectal cancer.
abstract: OBJECTIVE
  Introducing care pathways is seen as a method to realise patient-focussed care conform evidence-based guidelines. The goal of this study is to determine the long-term effects of a regional care pathway for patients with rectal cancer.
  
  
  METHODS
  Data on almost 400 patients with rectal carcinoma from three hospitals were obtained from the Netherlands Cancer Registry and the Dutch Surgical Colorectal Audit. Results on seven structure and process indicators were analysed and compared before and at two time points after implementing a regional care pathway over a total period from 2007 to 2012. To determine motivation and interpret the results, relevant professionals of the participating hospitals were interviewed.
  
  
  RESULTS
  After implementing the care pathway, the performance of computed tomography (CT) scans in the diagnostic phase significantly improved (p = 0.007/0.07). The number of patients discussed in the preoperative multidisciplinary team (MDT) meeting improved significantly (p = <0.001), and after implementing the care pathway, 94% of the patients were discussed. Further, a significant reduction in time between the first tumour biopsy and the MDT meeting was realised (p = 0.01). Professionals stated that the regional care pathway has led to more clarity about the patient route and more awareness about complying with evidence-based guidelines.
  
  
  CONCLUSIONS
  The regional care pathway provided a solid basis for uniforming care, working according evidence-based guidelines and further cooperation on regional level. For mainly the waiting and throughput times, the guidelines and norms had probably a stronger effect on the results than the care pathway.
authors: Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands, j.vanhoeve@iknl.nl.
authors: Jolanda C
authors: JC
authors: van Hoeve
authors: Marloes A G
authors: MA
authors: Elferink
authors: Joost M
authors: JM
authors: Klaase
authors: Ewout A
authors: EA
authors: Kouwenhoven
authors: Pieter Paul J B M
authors: PP
authors: Schiphorst
authors: Sabine
authors: S
authors: Siesling
mesh_terms: D001706:Biopsy; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D006739:Hospital Administration; D006801:Humans; D008279:Magnetic Resonance Imaging; D009426:Netherlands; D009937:Organizational Objectives; D010348:Patient Care Team; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed