Monitoring and improving care in thoracic surgery

Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthcare is dependent upon the availability of research disclosing the processes leading to healthcare improvement. This thesis aims to provide more insight into the concept of quality improvement, from the implementation of a multidisciplinary care path for thoracic lung cancer surgery to the identification of evidence-based quality of care indicators. Because individual quality of care indicators do not define the overall healthcare quality, a template for a composite measure was introduced, incorporating seven ‘desired’ healthcare outcomes (i.e. a ‘textbook outcome’). Until now, attempts to assess the quality of healthcare have mostly relied on individual and composite measures describing processes and outcomes, not focusing on the effect of treatment on the patients’ sense of well-being.
In this thesis the importance of patient reported outcome measures (PROMs) is underlined. PROMs can be used to evaluate the patients’well-being and to monitor the effect of a treatment over time. The knowledge and measurement of surgical and patient-related outcomes is essential to create and maintain a transparent, high-quality and cost-effective healthcare system.