Research & Practice: An evaluation of clinical outcomes and innovation in colorectal care

The colorectal segment of the bowel can be faced with a broad range of diseases, both malignant and benign. Surgical resection is a cornerstone in the treatment of all these conditions. In recent years, important improvements have been introduced in the care around colorectal care. Despite these efforts to improve quality of care, there is still a wide range in the incidence of complications of colorectal care in the Netherlands. Especially colorectal cancer occurs in older patients who are often more vulnerable and therefore more likely to experience complications after surgery. With the increasing age of the population, healthcare costs are only expected to increase over the coming years. In response to this, efforts have been made to pursue efficiency of care while maintaining quality. This movement is known as value-based health care, which prioritizes patient outcomes and the value that derives from the healthcare system. One of the goals of value-based health care is to strive for value transformation, by measuring and improving clinical outcomes. In striving for quality improvement, the value-based health care improvement cycle has been introduced, consisting of data collection, evaluation of outcomes and implementation of improvements.
This thesis addresses two main items that contribute to quality improvement in colorectal care according to the improvement cycle: the practical evaluation of clinical outcomes to assess their value to current care and the introduction of new improvement initiatives, aiming to continuously introduce improvement and innovation in colorectal care. The first part of this thesis shows favourable outcomes when a diverting colostomy is used in the treatment of left side obstructive colorectal cancer. Besides it suggests an advantage for robotic surgery in overweight patients with rectal cancer and gives insights on costs associated with robotic surgery, for short- and long-term outcomes. Furthermore, it dives into the possibility of early discharge pathway after colorectal surgery. The second part introduces new improvement initiatives such as a new surgical technique (intra-corporal robotic Kono-S anastomosis), feasibility of early discharge pathways, and a clinical decision tool to select high impact improvement initiatives in daily practice.
Looking forward to the future of the improvement cycle of value-based healthcare, this thesis highlights focus areas for future research: use of real-world data, validation and implementation of new improvement initiatives, and the use of patient & healthcare worker perspectives.