Aim
The European quality assurance scheme for colorectal cancer services (hereinafter referred to as ‘the scheme’) is designed to be a voluntary, modular certification scheme in the context of organised, population-based cancer screening programmes. It aims to support quality improvement and person-centred care in colorectal cancer services across Europe.
Description
The scheme defines a standard of colorectal cancer care through a set of quality requirements that covers the entire care pathway, from screening, diagnosis and treatment to supportive care. The requirements cover broad aspects of care: clinical effectiveness; safety; facilities, resources and workforce; and personal empowerment and experience. In addition, as the scheme covers the entire cancer care pathway, it includes several continuity-of-care requirements that help ensure that individuals or patients experience coherent, timely and uninterrupted care.
Together with the evidence-based European colorectal cancer guidelines, the scheme provides screening programmes, healthcare providers and policymakers with the instruments necessary to implement high-quality colorectal cancer care.
Approach
The scheme’s quality requirements are defined and selected in a structured and transparent process by the ECICC working group, whose members include healthcare professionals, epidemiologists, guideline developers, patients and caregivers. The working group’s decisions rely on structured input from topic-specific groups of experts in collaboration with an independent evidence-review team, and on feedback from experts at large via public consultations at multiple stages of the process.
This standardised, transparent process consists of the following essential steps.
- Topic-specific groups, composed of experts from the ECICC working group and the ECICC expert pool, describe general 'care pathways' for colorectal cancer screening and care. These pathways, depicted schematically in the development process, describe an individual’s detailed care journey, the associated healthcare services, and the aspects that are critical to be monitored and improved. The European colorectal cancer guidelines inform the care pathways for the screening and diagnosis processes.
- An external and independent evidence-review team, with specific expertise in the field, conducts systematic literature reviews of existing quality requirements, covering reviews of guidelines, indicator databases and quality assurance schemes across Europe. In cases where the requirements retrieved do not address all relevant critical steps in the defined colorectal cancer care pathway, the topic-specific groups may develop new ones.
- Through a voting process and based on the available evidence, the working group identifies a short list of quality requirements and indicators that are considered to have a significant impact on people-important outcomes.
- The topic-specific groups evaluate the quality requirements against three criteria: scientific soundness, responsiveness and feasibility. The quality requirements determined to be scientifically sound, responsive and feasible are proposed to the working group to be considered for inclusion in the scheme.
- The working group makes the final judgement on which requirements are included in the scheme based on the evaluation of the three criteria. These requirements include relevant quality indicators to monitoring the implementation of the European colorectal cancer guidelines.
- The adopted requirements are compiled into certification modules that are compatible with the organisation of services across Europe.
- The feasibility of the scheme is assessed through a public survey shared with colorectal cancer services across Europe. Feedback is collected on each individual requirement and on the overall feasibility of the certification modules and the scheme. A feasibility test in a healthcare environment further enables the initiative to identify and address any issues to ensure that the scheme is implementable in colorectal cancer care services across Europe.
- Feedback and outcomes from the feasibility test are integrated into the first implementable version of the scheme.
Implementation
The finalised European quality assurance scheme for colorectal cancer services is made available as a manual to all interested colorectal cancer care services (i.e. hospitals, clinics, units, diagnostic centres, and other organisations) to support quality improvement across diverse healthcare settings.
Colorectal cancer care services may opt to apply for certification. Certification under the scheme is awarded by accredited certification bodies and is underpinned by the European legislative framework on accreditation (defined in Regulation (EC) No 765/2008), which ensures recognition and acceptance of the scheme’s certification at European and international levels.