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2 results

  • 6 - Improving Quality of Care

  • from Part 1 - The Public Health Toolkit
  • Edited by Kirsteen Watson, University of Cambridge, Jan Yates, NHS England and NHS Improvement, Stephen Gillam, University of Cambridge
  • Book:
    Essential Public Health
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 108-123

  • Summary

    Effective health-care makes a large and increasing contribution to preventing disease and prolonging life by reducing the population burden of disease. However, only the right kind of health-care delivered in the right way, at the right time, to the right person can improve health. Health-care interventions that are powerful enough to improve population health are also powerful enough to cause harm if incorrectly used. How can public health specialists know whether their interventions are having the desired effect? Clinicians can monitor the impact of their treatments on an individual patient basis, but how do we examine the impact of a new service? This chapter looks at what we mean by quality of health-care and considers some frameworks for its evaluation.

  • The complexity and difficulty of diagnosing lung cancer: findings from a national primary-care study in Wales

  • Richard D. Neal, Iain J. Robbé, Malcolm Lewis, Ian Williamson, Jane Hanson
  • Journal:
    Primary Health Care Research & Development / Volume 16 / Issue 5 / September 2015
    Published online by Cambridge University Press:
    08 December 2014, pp. 436-449
    • Article
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  • Aim

    This paper aims to provide a detailed analysis of the diagnostic process of lung cancer from a primary-care perspective.

    Background

    Diagnosing lung cancer at a stage where curative treatment is possible remains a challenge. Beginning to understand the complexity and difficulty in the diagnostic journey should enable the development of interventions in order to facilitate timelier diagnosis.

    Methods

    A national study of significant events was conducted whereby general practitioners (GPs) in Wales were asked to report data relating to the diagnostic process of recent lung cancer diagnoses using a standard template. Both qualitative and quantitative data were analysed.

    Findings

    Case reports were received from 96 general practices on 118 patients. A total of 96 patients (81.4%) presented with respiratory symptoms. A total of 79 patients (66.9%) had a GP-initiated X-ray before diagnosis. A total of 23 patients (19.5%) had a chest X-ray that did not initially show suspicion of lung cancer. A total of 25 patients (21.2%) were diagnosed after a GP-initiated acute admission. Analysis of free-text qualitative data showed that, for many patients, their GP behaved in an exemplary manner. However, for some patients, the GP could have made more of the opportunities presented for timelier diagnosis. There were a number of atypical and complex presentations, where the opportunities for more timely diagnosis were more limited. A variety of causes of diagnostic delays in secondary care were reported. These findings will inform health policy, and will inform the design of interventions to try to facilitate more timely diagnosis for symptomatic patients. We encourage greater compliance with diagnostic guidelines and greater vigilance for patients presenting with atypical symptoms, as well as for patients whose initial chest X-rays are normal.