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Province Wide Clinical Governance Network for Clinical Audit for Quality Improvement in Endometrial Cancer Management
  1. Vincenzo Dario Mandato, PhD*,
  2. Debora Formisano, SD,
  3. Debora Pirillo, MD*,
  4. Gino Ciarlini, MD*,
  5. Lillo Bruno Cerami, MD,
  6. Alessandro Ventura, MD§,
  7. Lorenzo Spreafico, MD,
  8. Tamara Palmieri, MD,
  9. Giovanni Battista La Sala, Prof*,,,§,,# and
  10. Martino Abrate, MD*
  1. * Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova, University of Modena and Reggio Emilia;
  2. Statistics and Clinical Epidemiology Unit, Arcispedale S. Maria Nuova;
  3. Department of Obstetrics and Gynecology, Ospedale Magati, Scandiano;
  4. § Department of Obstetrics and Gynecology, Ospedale Civile, Guastalla;
  5. Department of Obstetrics and Gynecology, Ospedale Franchini, Montecchio;
  6. Department of Advanced Technology, Arcispedale S. Maria Nuova; and
  7. # Department of Obstetrics and Gynecology, Ospedale S. Anna, Castelnovo nè Monti, Reggio Emilia, Italy.
  1. Address correspondence and reprint requests to Vincenzo Dario Mandato, PhD, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, Italy. E-mail: VincenzoDario.Mandato{at}


Background According to the hub-and-spoke model introduced in the Provincial Healthcare System of Reggio Emilia, early endometrial cancer is treated in peripheral low-volume hospitals (spokes) by general gynecologist, whereas more complex cancers are treated by gynecological oncologists at the main hospital (hub).

Objective To guarantee a uniformly high standard of care to all patients with endometrial cancer treated in hub and spoke hospitals of Reggio Emilia Province.

Methods The specialists of the 5 hospitals of Reggio Emilia Province instituted an inter hospital and multidisciplinary oncology group to write common and shared guidelines based on evidence-based medicine through the use of clinical audit. They valued the process indicators before and after guidelines introduction identifying the site of improvement and verifying the standard achievement.

Results Diagnostic hysteroscopy use increased significantly from preguideline period, 53%, to postguideline period, 74%. Magnetic resonance use and accuracy increased significantly from preguideline to postguideline periods: 8.1% to 35.3% and 37.3% to 74.7%, respectively. Laparoscopy use increased from 1.6% (preguideline) to 18.6 (postguideline). Early surgical complications decreased from 16% (preguideline) to 9% (postguideline). Radiotherapy use increased from 14.% (preguideline) to 32.3% (postguideline).

Conclusion It is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.

  • Endometrial cancer
  • Audit
  • Guideline
  • Health care quality improvement
  • Team training

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  • The authors did not receive funds for this work.

  • The authors declare that there are no conflicts of interest.