PEARL Study: Improvement of Non-Hodgkin's Lymphoma Care

• Exposure to and experiences with the interventions [ Time Frame: after 1 year ] [ Designated as safety issue: No ]
  To study the feasibility of both strategies, a process evaluation has to give insight into the mechanisms and processes responsible for the result (= extent of adherence to the indicator set for optimal NHL care). The actual 'exposure' of the patients and professionals to the implementation elements, together with their experience with these elements may have influenced the final result (success or failure of adherence). Data about 'exposure' to the different interventions will be collected using questionnaires.
• Costs of the strategy and the changed care [ Time Frame: after 1 year ] [ Designated as safety issue: No ]
  Non-adherence to the multidisciplinary NHL guideline may lead to unnecessary medical interventions and more complications, and subsequently to efficiency losses. This economic evaluation compares the two implementation strategies. The perspective of this economic evaluation will be a health care perspective. Both the costs of the implementation strategy and changes in health care consumption will be assessed. The outcome should facilitate local health care decision making on implementation.
• Change from baseline in morbidity [ Time Frame: baseline and 1 year ] [ Designated as safety issue: No ]
  Morbidity is an important outcome measure for the effect of the intervention strategy.
• Differences between both groups in Patient Related Outcome Measures (PROMs) [ Time Frame: after 1 year ] [ Designated as safety issue: No ]
  Patient Related Outcome Measures as quality of life are important measures to evaluate the outcome of care from a patient perspective.

• Exposure to and experiences with the interventions [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  To study the feasibility of both strategies, a process evaluation has to give insight into the mechanisms and processes responsible for the result (= extent of adherence to the indicator set for optimal NHL care). The actual 'exposure' of the patients and professionals to the implementation elements, together with their experience with these elements may have influenced the final result (success or failure of adherence). Data about 'exposure' to the different interventions will be collected using questionnaires.
• Costs of the strategy and the changed care [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Non-adherence to the multidisciplinary NHL guideline may lead to unnecessary medical interventions and more complications, and subsequently to efficiency losses. This economic evaluation compares the two implementation strategies. The perspective of this economic evaluation will be a health care perspective. Both the costs of the implementation strategy and changes in health care consumption will be assessed. The outcome should facilitate local health care decision making on implementation.
• Change from baseline in morbidity [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Morbidity is an important outcome measure for the effect of the intervention strategy.
• Differences between both groups in Patient Related Outcome Measures (PROMs) [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Patient Related Outcome Measures as quality of life are important measures to evaluate the outcome of care from a patient perspective.

The main objective of the proposed study is to assess the effectiveness, feasibility and costs of a tailored strategy (developed in accordance with the barriers found and current practice) to improve care for patients with non-Hodgkin's lymphomas (NHL), compared to a common strategy of 'audit & feedback'.

In a previous study among 22 Dutch hospitals many gaps in the care for patients with non-Hodgkin's lymphomas (NHL) were found, compared to best evidence as described in guidelines. In a problem analysis study, barriers and facilitators for good quality of NHL-care were assessed and a tailored implementation strategy was developed, based on these findings. The proposed study aims at the effectiveness, feasibility and costs of this tailored strategy to improve quality of care for patients with an NHL in a clustered randomized controlled trial in 19 Dutch hospitals.

Multilevel regression analyses will be performed to evaluate the effectiveness of both strategies. Exposure to and experiences with the strategy elements will be analysed descriptively.

Regarding the costs, the two strategies are compared with a health care perspective. The input of resources will be assessed by collecting volumes of consumed resources and multiplying these by the price of each resource unit; the implementation process and consequently costs will be estimated by an Activity Based Costing (ABC) approach. The output will be determined by the level of adherence to the NHL quality indicators.

• Other: Implementation tools
  • Professionals receive audit & feedback
  • Patients (and clinicians) have access to a website with information tailored to patients with an NHL. This website gives insight into the logistic processes of each diagnostic tool and into the patients' personal care pathway.
  • Standardization of diagnostic and evaluative request forms and reports for clinicians.
  • Supporting material for standardizing the procedure for multidisciplinary meetings.
• Other: Standard intervention
  Standard intervention consists of audit&feedback

• Active Comparator: Standard implementation strategy
  Standard intervention
  Intervention: Other: Standard intervention
• Experimental: Innovative implementation strategy
  Implementation tools
  Intervention: Other: Implementation tools

Inclusion Criteria:

• Clinical diagnosis of non-Hodgkin lymphoma
• Diagnosed in one of the participating hospitals
• Able to read and understand Dutch