Quality assessment, assurance and improvement through clinical auditing The colorectal cancer case

Health is considered one of the most valuable virtues for a person and for society. Together with an ever-increasing proportion of the gross domestic product spend on healthcare, it is not surprising that quality of care is a hot topic of debate. Societal demand for the presence of a reliable quality assessment and assurance system in healthcare is likely to keep on growing.
Audit and Feedback is considered a promising tool for quality assessment, assurance, and to facilitate improvements. The studies in this thesis aim to contribute to the assessment and further improvement of the quality of colorectal cancer care, one of the most predominant cancers in the Netherlands and a major health burden, through the use of existing and the development of new clinical audit registries.
Among others, studies in this thesis show that the development of an audit registry for high volume procedures (e.g. colonoscopies) through automated extraction of data of the endoscopy systems, so without additional administrative burden, is feasible. In addition, audit and feedback can be used to closely monitor effects of current treatments, for example it shows that the surgical resections of benign lesions come with substantial morbidity and careful consideration for this type of treatment is warranted, but also demonstrate improvement potential. Furthermore, it is a valuable instrument to monitor the real-world effects of the introduction of new policies (e.g. introduction of screening program) and of (the expansion of the indication to higher risk patients of) new techniques (e.g. laparoscopic surgery). No signs were observed of risk averse behavior as a potential consequence of making outcome indicators publicly available.