Evaluación del Proceso Asistencial Cáncer de Mama

Resum

Breast cancer has become a major global health problem. At present, integrated care processes´ management constitutes a major organizational formulas aiming to improve services´ quality. This thesis aims to evaluate the impact of the breast cancer clinical pathways in Andalusia at organizational level, to identify deficient areas and make proposals for improvement. We performed a descriptive, cross-sectional multicenter study conducted in three phases: cultural adaptation and validation of the questionnaire "Self-Care Process Evaluation Tool" (CPSET) in the Spanish context, a comparative analysis of different care processes and evaluation of the Breast Cancer clinical pathway. First and second phase of the study included 283 health professionals from nine hospitals. Process Evaluation of Integrated Healthcare Breast cancer has been conducted in four Andalusian hospitals regarding the treatment of breast cancer. The process of cultural adaptation and validation of the CPSET questionnaire consisted on translation and back-translation of the questionnaire, experts´ judgement and pilot study. Content validation was performed through an exploratory factor analysis (EFA) with Varimax rotation and confirmatory factor analysis. We calculated the internal consistency by Cronbach's alpha. Univariate description of the sample was performed, multivariate analysis and a structural model of co-variance was applied for comparison between variables. Anova test and Welsh have been used when the conditions of normality and nonparametric Kruskal -Wallis test according to their applicability criteria were met. The results of the validation of the questionnaire were satisfactory, considering it a useful tool for the evaluation of care processes. As overall results, care processes structured and managed according to a clinical pathway have better outcomes on all dimensions compared to traditional management systems. The breast cancer clinical pathway implemented within the Andalusian Public Health System is part of a firm commitment to quality care improvement but there are deficient areas related to the coordination and monitoring of the process must be analyzed in depth to optimize its implementation and health outcomes. The breast cancer clinical pathway shows significant differences regarding its organization within participant hospitals showing different degrees of implementation at clinical level. Among the suggestions for improvement included there is a strong need to enhance the process coordination in all the different phases as well as to establish mechanisms to ensure continuity of care and follow-up of affected women throughout the process. The inclusion of new advanced roles such as the Advanced Practice Nurse could solve these needs as demonstrated by the results in other countries.