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La Rivista Italiana della Medicina di Laboratorio 2021 Settembre;17(3):165-72

DOI: 10.23736/S1825-859X.21.00109-2


language: Italian

The diagnostic-therapeutic care pathway for the management of chronic lymphoproliferative diseases in ULSS7 of the Veneto Region: where are we?

Alessandra FALDA 1 , Lucia ZENI 2, Fosca SIVIERO 1, Antonio ANTICO 1

1 Unità Operativa Complessa di Medicina di Laboratorio, ULSS7 Pedemontana, Vicenza, Italia; 2 Servizio di Medicina Legale e Qualità, ULSS7 Pedemontana, Vicenza, Italia

BACKGROUND: In 2018 ULSS7 of Veneto compiled the Diagnostic-Therapeutic Care Pathways (DTCPs) for hematological tumors. The objective of this work was first of all to verify the feasibility, in the field, of a quantitative evaluation of processes, and in particular of the efficiency of the DTCPs in the approach to chronic lymphoproliferative syndromes (CLS) with four chosen indicators: 1) incidence for the year 2019; 2) the percentage of cases with histological reporting time ≤10 days; 3) the percentage of cases with time from management to histological diagnosis ≤ 30 days; 4) the percentage of cases with time from the histological report to the therapeutic plan ≤28 days. We considered three “pre-DTCP, post-DTCP, and COVID” periods to verify, through the last three indicators, any differences in the three-time frames. Finally, concerning the three periods indicated above, we wanted to check whether there were any differences in the number of cytometric analyzes relating to CLS.
METHODS: As sources of data for the calculation of the indicators and for the time comparisons, 147 histological reports and 2116 cytometric surveys relating to CLS with dates between January 2017 and October 2020, as well as the medical records of the related patients were examined. To calculate the expected cases of CLS of B lymphocytes for the year 2019, the incidence data relating to our ULSS obtained from the Veneto Cancer Registry (VCR) for the three-years 2015-2017 period were used. One-way ANOVA test was used to evaluate the differences between periods.
RESULTS: The incidence for the year 2019 compared to the cases estimated from the VCR was eight vs. 14 for Hodgkin’s lymphomas (HL) and 71 vs. 76 for the other B-CLS; from the beginning of 2017 to October 2020, the histological reporting time ≤10 days was seen in 89.8% of the new cases; the time from taking charge to the histological diagnosis was ≤30 days in 72.7%, while the time from the histological report to the therapeutic plan was ≤28 days in 71% of cases. We set the threshold value ≥80% for indicators 2, 3 and 4. No statistically significant differences emerged in the COVID period with respect to the pre-and post-DTCP periods, neither concerning the value of indicators 2, 3 and 4, nor concerning the number of specific cytometric investigations.
CONCLUSIONS: Compared to the objectives set, the analysis carried out, revealed an incidence of CLS (not HL) comparable to that expected, indicator 2 above the pre-established threshold for the entire period examined and its fractions, and indicators 3 and 4 sub-threshold for the entire period considered and its fractions. As regards the last two indicators, the limitation of the unavailability of some data necessary for the evaluation was highlighted, as well as the criticality related to available hematologists.

KEY WORDS: Diagnostic-Therapeutic Care Pathways; Chronic Lymphoproliferative Syndromes; Indicators; Hub-Spoke

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