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The European Journal of Public Health Advance Access published online on July 13, 2005
The European Journal of Public Health, doi:10.1093/eurpub/cki013
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received January 15, 2004
Accepted May 5, 2004

Article

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon

Simos Kedikoglou 1*, Konstantinos Syrigos 2, Yannis Skalkidis 3, Fani Ploiarchopoulou 2, Nick Dessypris 1, and Eleni Petridou 4

1 Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
2 Third Department of Internal Medicine, Sotiria Hospital, Athens University Medical School, Athens, Greece
3 Second Department of Surgery, Aretaieion Hospital, Athens University Medical School, Athens, Greece
4 Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

* To whom correspondence should be addressed.
Simos Kedikoglou, E-mail: sjk{at}otenet.gr


  Abstract

Background: The quality improvement effort in clinical practice has focused mostly on ‘performance quality’, i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the ‘conformance quality’, i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. Methods: A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. Results: All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A ‘learning curve’ phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Conclusions: Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

Keywords: clinical protocols; implementation; learning curve; lung cancer.
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