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Open Access Study protocol

Improvement of hospital care for patients with non-Hodgkin’s lymphoma: protocol for a cluster randomized controlled trial (PEARL study)

Jozette JC Stienen1*, Rosella PMG Hermens1, Lianne Wennekes1, Saskia AM van de Schans8, Helena M Dekker2, Nicole MA Blijlevens3, Richard WM van der Maazen4, Eddy MM Adang5, Johan HJM van Krieken6 and Petronella B Ottevanger7

Author Affiliations

1 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen the Netherlands

2 Department of Radiology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

3 Department of Hematology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

4 Department of Radiotherapy, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

5 Department of Health Evidence, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

6 Department of Pathology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

7 Department of Medical Oncology, Radboud University Nijmegen Medical Centre, PO box 9101, 6500 HB Nijmegen, the Netherlands

8 Department of Registry and Research, Comprehensive Cancer Centre the Netherlands (CCC), PO Box 19079, 3501 DB Utrecht, the Netherlands

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Implementation Science 2013, 8:77  doi:10.1186/1748-5908-8-77

Published: 9 July 2013

Abstract

Background

Malignant lymphomas constitute a diverse group of cancers of lymphocytes. One well-known disease is Hodgkin’s lymphoma; the others are classified as non-Hodgkin’s lymphoma (NHL). NHLs are the most common hematologic neoplasms in adults worldwide, and in 2012 over 170,000 new cases were estimated in the United States and Europe.

In previous studies, several practice gaps in hospital care for patients with NHL have been identified. To decrease this variation in care, the present study aims to perform a problem analysis in which barriers to and facilitators for optimal NHL care will be identified and, based on these findings, to develop (tailored) improvement strategies. Subsequently, we will assess the effectiveness, feasibility and costs of the improvement strategies.

Methods/design

Barriers and facilitators will be explored using the literature, using interviews and questionnaires among physicians involved in NHL care, and patients diagnosed with NHL. The results will be used to develop a tailored improvement strategy. A cluster randomized controlled trial involving 19 Dutch hospitals will be conducted. Hospitals will be randomized to receive either an improvement strategy tailored to the barriers and facilitators found or, a standard strategy of audit and feedback.

The effects of both strategies will be evaluated using previously developed quality indicators. Adherence to the indicators will be measured before and after the intervention period based on medical records from newly diagnosed NHL patients. To study the feasibility of both strategies, a process evaluation will be additionally performed. Data about exposure to the different elements of the strategies will be collected using questionnaires. Economic evaluation from a healthcare perspective will compare the two implementation strategies, where the costs of the implementation strategy and changes in healthcare consumption will be assessed.

Discussion

The presence of variation in the use of diagnostic tests, treatment, and follow-up between different physicians in different hospitals in the Netherlands is important for patients. To reduce the existing variation in care, implementation of tailored interventions to improve NHL care is necessary.

Trial registration

This trial is registered at ClinicalTrial.gov as the PEARL study, registration number NCT01562509.

Keywords:
non-Hodgkin’s lymphoma; Quality of healthcare; Guidelines; Oncology; Implementation; Interventions