Sailing upwind Optimizing quality-of-care evaluation through source data utilization in head and neck cancer treatment

This thesis evaluates the quality of care in the Dutch head and neck cancer (HNC) care from three perspectives: the patient perspective, nationwide insights, and composite quality measures.
The first part focuses on the patient perspective, emphasizing the integration of patient-reported outcome measures (PROMs) into routine care. Chapter 2 explores how patients and healthcare professionals perceive and use PROMs in clinical practice, stressing the need for meaningful implementation. Chapter 3 evaluates preliminary results on the clinical validity and relevance of the FACE-Q HNC module within a Dutch cohort. Chapter 4 presents a systematic review on the prevalence and measurement of decisional conflict and regret, highlighting the need for more tailor-made patient-centered decision-making support.
The second part offers nationwide insights through the Dutch Head and Neck Audit (DHNA) in Chapters 5 and 6. Chapter 5 reports on trends and improvements in treatment timeliness from 2015 to 2022, while Chapter 6 examines variation in reconstructive surgery techniques and outcomes across centers. Chapter 7 investigates how the COVID-19 pandemic affected diagnostic and treatment, underscoring the value of national data infrastructures in maintaining care continuity during crisis.
The third part introduces composite measures to evaluate care quality as a continuum. Chapter 8 describes the development of a structured electronic care pathway forming the foundation for in-house dashboards for real-time quality monitoring. Chapters 9 and 10 define and assess the ‘Textbook Outcome’ as a short-term success metric and explore its relationship with survival, while emphasizing the importance of case-mix adjustments in interpreting these measures.