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首页> 外文期刊>Implementation Science >Improvement of hospital care for patients with non-Hodgkin’s lymphoma: protocol for a cluster randomized controlled trial (PEARL study)
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Improvement of hospital care for patients with non-Hodgkin’s lymphoma: protocol for a cluster randomized controlled trial (PEARL study)

机译：改善非霍奇金淋巴瘤患者的医院护理：一项整群随机对照试验（PEARL研究）的方案

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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.
机译：背景恶性淋巴瘤构成淋巴细胞的多种癌症。一种著名的疾病是霍奇金淋巴瘤;其他则归类为非霍奇金淋巴瘤（NHL）。 NHL是全球成人中最常见的血液肿瘤，2012年，在美国和欧洲，估计有170,000例新病例。在先前的研究中，已经确定了NHL患者在医院护理中的一些实践空白。为了减少这种护理差异，本研究旨在进行问题分析，找出最佳NHL护理的障碍和促进者，并根据这些发现，制定（量身定制）改善策略。随后，我们将评估改进策略的有效性，可行性和成本。方法/设计将使用文献探索障碍和协助者，并使用NHL护理医生和被诊断为NHL的患者进行访谈和问卷调查。结果将用于制定量身定制的改进策略。将进行一项涉及19家荷兰医院的整群随机对照试验。医院将被随机分配，以接受针对所发现的障碍和协助者量身定制的改进策略，或者接受审计和反馈的标准策略。将使用先前开发的质量指标来评估这两种策略的效果。在干预期之前和之后，将根据新诊断的NHL患者的病历来测量对指标的遵守情况。为了研究这两种策略的可行性，将另外进行过程评估。将使用问卷收集有关暴露于策略不同元素的数据。从医疗保健的角度进行经济评估将比较这两种实施策略，其中将评估实施策略的成本和医疗保健消费的变化。讨论荷兰不同医院的不同医生之间在诊断测试，治疗和随访使用方面存在差异，对患者而言很重要。为了减少现有的护理差异，必须实施量身定制的干预措施以改善NHL护理。试验注册该试验已在ClinicalTrial.gov上注册为PEARL研究，注册号为NCT01562509。

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