Line 4 – New organizational models: PDTA and indicators

Description

The main objective pursued in the drafting of the PDTA of the Veneto Regional Oncological Network – ROV (DGR 2067/2013) is to ensure timeliness in taking care of patients, adequate levels of care and continuity of care from the precise moment in which the patient enters the path, to multidisciplinary evaluation, up to the end of life.
The definition of PDTAs also provides for the identification of structure, process and outcome indicators which will allow the acquisition of “effectiveness” data of diagnostic, therapeutic and organizational innovations.

Background

The IOV is a fundamental hub in the hospital and territorial Regional Oncological Network, as it acts as a HUB for its coordination in close harmony with all the organizations in the Region. Among its objectives is to define and share Diagnostic Therapeutic Assistance Pathways for the various types of cancer and to activate systems of verification and indicators for monitoring the appropriateness of care pathways and oncological treatment oriented to the quality and safety of the patient. Therefore, the collection of indicators within the Institute becomes of strategic importance, which also assumes essential importance at the regional level. The relevance of real world data is growing in light of the continuous diagnostic, therapeutic and organizational innovations in the oncology field.

Rationale

The monitoring of the PDTA through specific performance indicators makes it possible to analyze the assistance junctions put in place at the individual company declination. The verification in the field of the improvements introduced by the PDTAs is carried out through the calculation of indicators, ie variables with other information content, which allow a synthetic evaluation of complex phenomena and help to guide decisions. The indicators are currently constructed using the information made available by current information flows (specialist assistance, hospitalizations, pharmaceuticals, home care, regional mortality register) suitably integrated with record linkage techniques.
The ability to detect structure, process and outcome indicators will allow to produce reliable data from clinical practice. The relevance of “effectiveness” data deriving from clinical practice is now also recognized by the regulatory authorities as the only way to obtain:

• long-term safety data of innovative therapies,
• efficacy data in patients under / not represented in clinical trials (elderly, with comorbidities, compromised clinical conditions, taking various drugs),
• efficacy data in tumors / rare clinical pictures with insufficient data from clinical studies,
• data on therapeutic sequences.

Global Goals

Evaluation of the adherence to the indicators expressed by the PDTAs of the ROV, of the patients in charge of the IOV in the various treatment paths, specifically by:

• monitoring adherence to indicators;
• implementing internal audits;
• analyzing any corrective systems;
• acquiring outcome data.

Expected and measurable results over the three-year period

Activation of an application that allows the detection of structure and process indicators “detectable” by the regional information flows in order to allow the verification of the real taking in charge of the cancer patient as defined in the various PDTAs of the ROV. Measurable activities for the verification of the results through the quantitative definition of the indicator are:

• waiting time to start post-operative chemotherapy / radiotherapy
• chemotherapy in the last 30 days of life
• reduction of inappropriate diagnostic tests (CT, MRI, PET, etc)
• definition of evaluation tools on the effectiveness of innovative therapies.