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Liu M, Yu Q, Liu Y. Developing quality indicators for cancer hospitals in China: a national modified Delphi process. BMJ Open 2024; 14:e082930. [PMID: 38594187 PMCID: PMC11015267 DOI: 10.1136/bmjopen-2023-082930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE Although demand and supply of cancer care have been rapidly increasing in recent decades, there is a lack of systemic quality measurement for cancer hospitals in China. This study aimed to develop a set of core indicators for measuring quality of care for cancer hospitals in China. DESIGN The development of quality indicators was based on a literature review and a two-round modified Delphi survey. The theoretical framework and initial indicators were identified through the comprehensive literature review, and the selection of quality indicators relied on experts' consensus on the importance and feasibility of indicators by the modified Delphi process. In addition, indicator weight was identified using the analytical hierarchical process method and percentage weight method. SETTING AND PARTICIPANTS A panel of leading experts including oncologists, cancer care nurses, quality management experts from various regions of China were invited to participate in the two-round modified Delphi process from October to December 2020. A total of 25 experts completed the two-round modified Delphi process. RESULTS The experts reached consensus on a set of 47 indicators, comprising 17 structure indicators, 19 process indicators and 11 outcome indicators. Experts gave much higher weight to outcome indicators (accounting for 53.96% relative weight) than to structure (16.34%) and process (29.70%) indicators. In addition, experts also showed concerns and gave suggestions on data availability of specific outcome indicators. CONCLUSIONS Drawing on the comprehensive literature review and the modified Delphi process, this study developed a core set of quality indicators that can be used to evaluate quality performance of cancer hospitals. This is helpful in supporting quality cancer care in China and will provide new insights into the systemic measurement of cancer care internationally.
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Affiliation(s)
- Meicen Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingyuan Yu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Aggarwal A, Nossiter J, Parry M, Sujenthiran A, Zietman A, Clarke N, Payne H, van der Meulen J. Public reporting of outcomes in radiation oncology: the National Prostate Cancer Audit. Lancet Oncol 2021; 22:e207-e215. [DOI: 10.1016/s1470-2045(20)30558-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
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Kreienberg R, Wöckel A, Wischnewsky M. Highly significant improvement in guideline adherence, relapse-free and overall survival in breast cancer patients when treated at certified breast cancer centres: An evaluation of 8323 patients. Breast 2018; 40:54-59. [PMID: 29698925 DOI: 10.1016/j.breast.2018.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/15/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Certified multi-disciplinary breast cancer centres (CBCs) have been established worldwide. Development of CBCs, guideline-adherent systemic therapy and surgical management should now show an impact on outcomes. This analysis aimed to investigate whether guideline adherence (GA) rates, relapse-free survival (RFS) and overall survival (OS) have significantly improved at CBCs compared to the pre-certification period. MATERIALS AND METHODS 8323 patients with primary breast cancer were treated in 17 German CBCs, which had been certified between 2003 and 2007 [2003 (n = 1), 2004 (n = 6), 2005 (n = 3), 2006 (n = 6) and 2007 (n = 1)]. 3544 patients (42.6%) were treated before certification and 4779 patients (57.4%) after certification. RESULTS AND CONCLUSION A highly significant (p < 0.001) difference in 100%-GA was found between the various hospitals before certification (min 25.0%; max 54.6%). In 2008, when all participating hospitals were certified, the GA rate was 61.8% (min 39.5%, max 74.4%) and 69.2% (min 45.9%, max 86.4%) for patients <75 y (n = 6675). The difference between pre-certification 100%-GA (46.9%) and post-certification (57.2%) was highly significant (p < 0.001). RFS and OS were both significantly better after certification compared to the pre-certification period (RFS: HR = 0.79; 95% CI: 0.68-0.92; p = 0.003; OS: HR = 0.75; 95% CI: 0.65-0.85; p < 0.001). 5-year RFS (OS) of patients <75 y was 89.6% (85.4%) pre-certification and 91.4% (89.5%) post-certification. Since improvement in GA and outcomes correlated as well, GA remains a highly significant prognostic factor for RFS and OS regardless of NPI, intrinsic subtype and adjuvant systemic therapy. This suggests that the certification process is strongly associated with improvements in outcome.
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van Bommel AC, Spronk PE, Vrancken Peeters MJT, Jager A, Lobbes M, Maduro JH, Mureau MA, Schreuder K, Smorenburg CH, Verloop J, Westenend PJ, Wouters MW, Siesling S, Tjan - Heijnen VC, van Dalen T. Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit. J Surg Oncol 2016; 115:243-249. [DOI: 10.1002/jso.24516] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/29/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Annelotte C.M. van Bommel
- Department of Surgery; Leiden University Medical Centre; Leiden The Netherlands
- Dutch Institute for Clinical Auditing; Leiden The Netherlands
| | - Pauline E.R. Spronk
- Department of Surgery; Leiden University Medical Centre; Leiden The Netherlands
- Dutch Institute for Clinical Auditing; Leiden The Netherlands
| | | | - Agnes Jager
- Department of Medical Oncology; Erasmus MC Cancer Institute, University Medical Centre; Rotterdam The Netherlands
| | - Marc Lobbes
- Department of Radiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - John H. Maduro
- Department of Radiation Oncology; University of Groningen, University Medical Centre Groningen; Groningen The Netherlands
| | - Marc A.M. Mureau
- Department of Plastic and Reconstructive Surgery; Erasmus MC Cancer Institute, University Medical Centre; Rotterdam The Netherlands
| | - Kay Schreuder
- Department of Research; Comprehensive Cancer Organisation the Netherlands (IKNL); Utrecht The Netherlands
| | - Carolien H. Smorenburg
- Department of Medical Oncology; Netherlands Cancer Institute/Antoni van Leeuwenhoek; Amsterdam The Netherlands
| | - Janneke Verloop
- Department of Research; Comprehensive Cancer Organisation the Netherlands (IKNL); Utrecht The Netherlands
| | - Pieter J. Westenend
- Department of Pathology; Laboratory for pathology Dordrecht e.o.; Dordrecht The Netherlands
| | - Michel W.J.M. Wouters
- Dutch Institute for Clinical Auditing; Leiden The Netherlands
- Department of Surgery; Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Sabine Siesling
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
- Department of Health Technology and Services Research; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede The Netherlands
| | - Vivianne C.G. Tjan - Heijnen
- Department of Medical Oncology; Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology; Maastricht The Netherlands
| | - Thijs van Dalen
- Department of Surgery; Diakonessenhuis Utrecht; Utrecht The Netherlands
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Is there evidence for better health care for cancer patients in certified centers? A systematic review. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0728-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Thonon F, Watson J, Saghatchian M. Benchmarking facilities providing care: An international overview of initiatives. SAGE Open Med 2015; 3:2050312115601692. [PMID: 26770800 PMCID: PMC4712789 DOI: 10.1177/2050312115601692] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully.
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Affiliation(s)
- Frédérique Thonon
- European and International Affairs, Gustave Roussy, Villejuif, France
| | - Jonathan Watson
- HealthClusterNet, Unit 1, Carleton Business Park, Skipton, UK
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Jacke CO, Albert US, Reinhard I, Kalder M. Convergence with SEER database achieved by a breast cancer network: a longitudinal benchmark of 5-year relative survival. J Cancer Res Clin Oncol 2014; 141:1109-18. [PMID: 25512079 DOI: 10.1007/s00432-014-1879-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/18/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE To benchmark outcomes of a German breast cancer network with the Surveillance Epidemiology and End Results programme (SEER) of the USA from a longitudinal point of view. METHODS All women receiving primary breast cancer therapy of three hospitals in a rural district of Marburg-Biedenkopf (Germany) of time intervals 1996-1997 and 2003-2004 were used to define local benchmark objects. Data from SEER-programme contributed longitudinal benchmark objects from national level (1988-2004). All benchmark objects were compared with the time-fixed benchmark reference of SEER (2004). Stage distributions and 5-year relative survival ratios were combined to estimate standardized screening-, case-mix-, work-up-, treatment- and relative overall performance index. RESULTS From the entry cohort of 877 German women, 97.7 % of the patients accounted for the institutional sample (N = 857) and 65.8 % accounted for the regional sample (N = 577). Stage distributions, relative survival ratios and indices of the German breast cancer network improved over time. Developed indices converged with SEER (2004). CONCLUSIONS Effectiveness gap between one exemplary German breast cancer network and international benchmark defined by SEER has been closed. Reasons are manifold, and further research is recommended.
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Affiliation(s)
- Christian O Jacke
- Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Square J5, 68159, Mannheim, Germany,
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Corradini S, Niemoeller OM, Niyazi M, Manapov F, Haerting M, Harbeck N, Belka C, Kahlert S. Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution. Strahlenther Onkol 2014; 190:352-7. [PMID: 24638237 DOI: 10.1007/s00066-013-0540-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/09/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role of postoperative radiotherapy in breast-conserving therapy is undisputed. However, optimal timing of adjuvant radiotherapy is an issue of ongoing debate. This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery-radiotherapy intervals on local control and overall survival. PATIENTS AND METHODS Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period (1990-2006) were analyzed. Patients were assigned to two groups (CT+/CT-) according to chemotherapy status. A delay in the initiation of radiotherapy was defined as > 7 weeks (CT- group) and > 24 weeks (CT+ group). RESULTS The 10-year regional recurrence-free survival for the CT- and CT+ groups were 95.6 and 86.0 %, respectively. A significant increase in the median surgery-radiotherapy interval was observed over time (CT- patients: median of 5 weeks in 1990-1992 to a median of 6 weeks in 2005-2006; CT+ patients: median of 5 weeks in 1990-1992 to a median of 21 weeks in 2005-2006). There was no association between a delay in radiotherapy and an increased local recurrence rate (CT- group: p = 0.990 for intervals 0-6 weeks vs. ≥ 7 weeks; CT+ group: p = 0.644 for intervals 0-15 weeks vs. ≥ 24 weeks) or decreased overall survival (CT- group: p = 0.386 for intervals 0-6 weeks vs. ≥ 7 weeks; CT+ group: p = 0.305 for intervals 0-15 weeks vs. ≥ 24 weeks). CONCLUSION In the present cohort, a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups (CT-/CT+). However, in the absence of randomized evidence, delays in the initiation of radiotherapy should be avoided.
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Affiliation(s)
- S Corradini
- Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany,
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Khan C, Ollenschläger G. Wirksamkeit von Qualitätsprogrammen in der stationären Versorgung in Deutschland – eine Literaturanalyse. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108:576-86. [DOI: 10.1016/j.zefq.2014.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jacke CO, Reinhard I, Albert US. Using relative survival measures for cross-sectional and longitudinal benchmarks of countries, states, and districts: the BenchRelSurv- and BenchRelSurvPlot-macros. BMC Public Health 2013; 13:34. [PMID: 23316692 PMCID: PMC3602052 DOI: 10.1186/1471-2458-13-34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background The objective of screening programs is to discover life threatening diseases in as many patients as early as possible and to increase the chance of survival. To be able to compare aspects of health care quality, methods are needed for benchmarking that allow comparisons on various health care levels (regional, national, and international). Objectives Applications and extensions of algorithms can be used to link the information on disease phases with relative survival rates and to consolidate them in composite measures. The application of the developed SAS-macros will give results for benchmarking of health care quality. Data examples for breast cancer care are given. Methods A reference scale (expected, E) must be defined at a time point at which all benchmark objects (observed, O) are measured. All indices are defined as O/E, whereby the extended standardized screening-index (eSSI), the standardized case-mix-index (SCI), the work-up-index (SWI), and the treatment-index (STI) address different health care aspects. The composite measures called overall-performance evaluation (OPE) and relative overall performance indices (ROPI) link the individual indices differently for cross-sectional or longitudinal analyses. Results Algorithms allow a time point and a time interval associated comparison of the benchmark objects in the indices eSSI, SCI, SWI, STI, OPE, and ROPI. Comparisons between countries, states and districts are possible. Exemplarily comparisons between two countries are made. The success of early detection and screening programs as well as clinical health care quality for breast cancer can be demonstrated while the population’s background mortality is concerned. Conclusions If external quality assurance programs and benchmark objects are based on population-based and corresponding demographic data, information of disease phase and relative survival rates can be combined to indices which offer approaches for comparative analyses between benchmark objects. Conclusions on screening programs and health care quality are possible. The macros can be transferred to other diseases if a disease-specific phase scale of prognostic value (e.g. stage) exists.
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Affiliation(s)
- Christian O Jacke
- Central Institute of Mental Health, Medical Faculty Mannheim/University Heidelberg, Square J5, 68159 Mannheim, Germany.
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Wallwiener M, Brucker SY, Wallwiener D. Multidisciplinary breast centres in Germany: a review and update of quality assurance through benchmarking and certification. Arch Gynecol Obstet 2012; 285:1671-83. [PMID: 22314433 PMCID: PMC3351617 DOI: 10.1007/s00404-011-2212-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 12/31/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE This review summarizes the rationale for the creation of breast centres and discusses the studies conducted in Germany to obtain proof of principle for a voluntary, external benchmarking programme and proof of concept for third-party dual certification of breast centres and their mandatory quality management systems to the German Cancer Society (DKG) and German Society of Senology (DGS) Requirements of Breast Centres and ISO 9001 or similar. In addition, we report the most recent data on benchmarking and certification of breast centres in Germany. METHODS Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes. RESULTS AND CONCLUSIONS Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving. The voluntary benchmarking programme has gained wide acceptance among DKG/DGS-certified breast centres. This is evidenced by early results from one of the largest studies in multidisciplinary cancer services research, initiated by the DKG and DGS to implement certified breast centres. The goal of establishing a nationwide network of certified breast centres in Germany can be considered largely achieved. Nonetheless the network still needs to be improved, and there is potential for optimization along the chain of care from mammography screening, interventional diagnosis and treatment through to follow-up. Specialization, guideline-concordant procedures as well as certification and recertification of breast centres remain essential to achieve further improvements in quality of breast cancer care and to stabilize and enhance the nationwide provision of high-quality breast cancer care.
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Affiliation(s)
- Markus Wallwiener
- Department of Obstetrics and Gynaecology, University of Heidelberg, Voßstraße 9, 69115 Heidelberg, Germany.
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Singer S, Dieng S, Wesselmann S. Psycho-oncological care in certified cancer centres--a nationwide analysis in Germany. Psychooncology 2012; 22:1435-7. [PMID: 22855347 DOI: 10.1002/pon.3145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/16/2012] [Accepted: 07/09/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Over the last few years, a nationwide voluntary certification system for cancer centres has been established in Germany. To qualify for certification, cancer centres must provide psycho-oncological care to every patient who needs it. The aim of this study was to find out how many patients have been treated by a psycho-oncologist in the certified centres. METHODS All cancer centres in Germany that were re-certified in 2010 provided data documenting how many patients with primary cancer received at least 30 min of psycho-oncological consultation in 2009. RESULTS Data from n = 456 certified cancer centres were available. In the centres, a total of 36,165 patients were seen by a psycho-oncologist for at least 30 min, representing 37.3% of all patients in the centres. The highest percentage of patients who received psycho-oncological care was found in breast cancer centres (66.7%), and the lowest in prostate cancer centres (6.8%). Half of the patients (50.0%) in gynaecological cancer centres, 37.7% in colon cancer centres and 25.4% in lung cancer centres received psycho-oncological care. CONCLUSIONS Compared with non-certified centres, the proportion of patients receiving psycho-oncological care in certified cancer centres has increased.
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Affiliation(s)
- Susanne Singer
- Department of Epidemiology and Health Care Research, University of Mainz, Germany.
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Ferrua M, Couralet M, Nitenberg G, Morin S, Serin D, Minvielle E. Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery. BMC Health Serv Res 2012; 12:167. [PMID: 22721001 PMCID: PMC3438032 DOI: 10.1186/1472-6963-12-167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 06/21/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Because breast cancer is a major public health issue, it is particularly important to measure the quality of the care provided to patients. Survival rates are affected by the timeliness of care, and waiting times constitute key quality criteria. The aim of this study was to develop and validate a set of quality indicators (QIs) relative to the timeliness and organisation of care in new patients with infiltrating, non-inflammatory and metastasis-free breast cancer undergoing surgery. The ultimate aim was to use these QIs to compare hospitals. METHODS The method of QI construction and testing was developed by COMPAQ-HPST. We first derived a set of 8 QIs from consensus guidelines with the aid of experts and professional associations and then tested their metrological properties in a panel of 60 volunteer hospitals. We assessed feasibility using a grid exploring 5 dimensions, discriminatory power using the Gini coefficient as a measure of dispersion, and inter-observer reliability using the Kappa coefficient. RESULTS Overall, 3728 records were included in the analyses. All 8 QIs showed acceptable feasibility (but one QI was subject to misinterpretation), fairly strong agreement between observers (Kappa = 0.66), and wide variations in implementation among hospitals (Gini coefficient < 0.45 except for QI 6 (patient information)). They are thus suitable for use to compare hospitals and measure quality improvement. CONCLUSIONS Of the 8 QIs, 3 are ready for nationwide implementation (time to surgery, time to postoperative multidisciplinary team meeting (MDTM), conformity of MDTM). Four are suitable for use only in hospitals offering surgery with on-site postoperative treatment (waiting time to first appointment after surgery, patient information, time to first postoperative treatment, and traceability of information relating to prognosis). Currently, in the French healthcare system, a patient receives cancer care from different institutions whose databases cannot as yet be easily merged. Nationwide implementation of QIs covering the entire care pathway will thus be a challenge.
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Affiliation(s)
- Marie Ferrua
- INSERM-COMPAQ-HPST project, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, FRANCE
| | - Mélanie Couralet
- INSERM-COMPAQ-HPST project, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, FRANCE
| | - Gérard Nitenberg
- INSERM-COMPAQ-HPST project, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, FRANCE
| | - Sandrine Morin
- Haute Autorité de Santé, 2 avenue du Stade de France, St Denis la Plaine Cedex, 93218, FRANCE
| | - Daniel Serin
- Institut Sainte Catherine, 1750 Chemin du Lavarin, Avignon, 84000, FRANCE
| | - Etienne Minvielle
- INSERM-COMPAQ-HPST project, Institut de Cancérologie Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, FRANCE
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Dunst J, Dellas K. Margins! Margins. Margins? How Important Is Margin Status in Breast-Preserving Therapy? Breast Care (Basel) 2012; 6:359-362. [PMID: 22619645 DOI: 10.1159/000333145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Margin status is surely a prognostic factor in patients undergoing breast-conserving therapy, but its impact is probably overestimated in case of adequate adjuvant radiotherapy. Radiotherapy improves local control after excision of the primary tumor in all subgroups of patients. There is, in contrast, no evidence that a certain margin width or a re-resection improves local control.
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Affiliation(s)
- Jürgen Dunst
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Strahlentherapie, Lübeck, Germany
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Biancosino A, Bremer M, Karstens J, Biancosino C, Meyer A. Postoperative periclavicular radiotherapy in breast cancer patients with 1–3 positive axillary lymph nodes. Strahlenther Onkol 2012; 188:417-23. [DOI: 10.1007/s00066-012-0083-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
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Blank E, Willich N, Fietkau R, Popp W, Schaller-Steiner J, Sack H, Wenz F. Evaluation of time, attendance of medical staff, and resources during radiotherapy for breast cancer patients. The DEGRO-QUIRO trial. Strahlenther Onkol 2012; 188:113-9. [PMID: 22241435 DOI: 10.1007/s00066-011-0020-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/10/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND PURPOSE To conform to recommendations regarding the treatment of breast cancer, an estimation of costs and personnel to assure treatment is required. To date no recommendations based on real time measurements are available. The DEGRO (German Society of Radiation Oncology), therefore, initiated a prospective multicenter evaluation of core procedures of radiotherapy. In this analysis, the results regarding human resources and room occupation during the treatment of breast cancer are presented. PATIENTS AND METHODS Three academic radiation oncology centers (Erlangen, Münster, Mannheim) prospectively documented their workflow and working time for all breast cancer patients from July-October 2008. Subsequently, a statistical analysis was performed. RESULTS The longest working time of physicians was the definition of the target volume and organs at risk (mean 33 min). Furthermore, physicians needed much time for general tasks, which included conversations. Physicists needed the most time for treatment planning and authorization (64 min), whereas technicians were mostly needed in day-to-day radiotherapy treatment (15 min, 31 min including verification). Despite significant differences in specific steps between centers, overall working times and room occupation were comparable and representative. Special procedures (intraoperative radiotherapy/multicatheter brachytherapy) required considerable amounts of additional working time of physicians and physicists. CONCLUSION In this prospective analysis, data of human resources and room occupation during treatment of breast cancer are presented for the first time. Each patient consumes about 12 h of human resources for treatment and 3.75 h for general tasks (physicians 4.7 h, physicists 1.8 h, and technicians 9.2 h).
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Affiliation(s)
- E Blank
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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Fietkau R, Budach W, Zamboglou N, Thiel HJ, Sack H, Popp W. Time management in radiation oncology: development and evaluation of a modular system based on the example of rectal cancer treatment. The DEGRO-QUIRO trial. Strahlenther Onkol 2011; 188:5-11. [PMID: 22194028 DOI: 10.1007/s00066-011-0003-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal was to develop and evaluate a modular system for measurement of the work times required by the various professional groups involved in radiation oncology before, during, and after serial radiation treatment (long-term irradiation with 25-28 fractions of 1.8 Gy) based on the example of rectal cancer treatment. MATERIALS AND METHODS A panel of experts divided the work associated with providing radiation oncology treatment into modules (from the preparation of radiotherapy, RT planning and administration to the final examination and follow-up). The time required for completion of each module was measured by independent observers at four centers (Rostock, Bamberg, Düsseldorf, and Offenbach, Germany). RESULTS A total of 1,769 data sets were collected from 63 patients with 10-489 data sets per module. Some modules (informed consent procedure, routine treatments, CT planning) exhibited little deviation between centers, whereas others (especially medical and physical irradiation planning) exhibited a wide range of variation (e.g., 1 h 49 min to 6 h 56 min for physical irradiation planning). The mean work time per patient was 12 h 11 min for technicians, 2 h 59 min for physicists, and 7 h 6 min for physicians. CONCLUSION The modular system of time measurement proved to be reliable and produced comparable data at the different centers. Therefore, the German Society of Radiation Oncology (DEGRO) decided that it can be extended to other types of cancer (head and neck, prostate, and breast cancer) with appropriate modifications.
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Affiliation(s)
- R Fietkau
- Department of Radiation Oncology, Erlangen University Hospital, Universitätsstr. 27, 91054, Erlangen, Germany.
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Souchon R, Dunst J. The Challenge of Integrating Radiotherapy in the Multimodal Treatment of Breast Cancer. Breast Care (Basel) 2011; 6:345-346. [PMID: 22619642 PMCID: PMC3357137 DOI: 10.1159/000334227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Rainer Souchon
- MVZ Radioonkologie, Klinik für Radioonkologie, Universitätsklinikum Tübingen, Germany
| | - Juergen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
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