Regional Audit and Feedback Intervention to Improve Quality of Care in Ovarian Cancer Treatment: The Easy-Net Experience

Purpose: In 2009, a regional audit on ovarian cancer in the Regional Cancer Care Network (RCCN) of Piemonte (Italy) documented that patients were widely distributed across different treatment centers, with evidence of suboptimal care. We present the re-audit and feedback (A&F) intervention performed in 2016-2020 and the variation on quality of care and outcomes. Methods: An A&F intervention was implemented across gynecologic units treating ovarian cancer in Piemonte. Key recommendations and indicators were identified from international guidelines. Global adherence to guideline recommendations was measured as the mean percentage of adherence across all the indicators. Data were collected retrospectively (May-December 2016, baseline period) and prospectively (May 2017-September 2020). Change in adherence to recommendations over time was monitored and feedback provided during quarterly meetings. Overall survival was identified as clinical outcome. Results: Among 1,030 women (77% advanced stage), the global adherence to guidelines increased by 2.1% (95% CI, 1.6 to 2.6) every 6 months, from 51.3% to 70.4%. The likelihood of treatment in high-volume surgical centers and multidisciplinary team discussions before treatment increased over time (odds ratio [OR], 1.15 [95% CI, 1.08 to 1.21] and OR, 1.21 [95% CI, 1.15 to 1.28]). Five-year survival was 47% overall (87% among early and 35% among advanced stages). Although no consistent trend in survival was observed during the A&F period, a 10% increase in global adherence was associated with improved 5-year survival (hazard ratio, 0.91 [95% CI, 0.87 to 0.95]). Conclusion: The implementation of this A&F initiative was associated with improvements in quality-of-care indicators for ovarian cancer, highlighting the potential value of A&F methodologies to support quality improvement activities.