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Utzig M, Hoffmann H, Reinmuth N, Schütte W, Langer T, Lobitz J, Rückher J, Wesselmann S. Development and Update of Guideline-based Quality Indicators in Lung Cancer. Pneumologie 2024; 78:250-261. [PMID: 38081218 DOI: 10.1055/a-2204-4879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND In 2022, an update of the German lung cancer guideline, first published in 2010 and revised in 2018, was released. This article aims to show the process of updating, developing, and implementing guideline-based quality indicators (QI) into the certification system for lung cancer centers (LCC). METHODS A multidisciplinary and interprofessional working group revised the guideline QIs from 2018 using the strong recommendations of the guideline update, a systematic review for QIs, and the results of the implemented QIs from LCC. RESULTS For 4 out of 8 indicators from the 2018 guideline, the LCC showed an improved implementation of the requirements in the last 3 years (2018-2020). For 3 indicators, the median of the results was constant at a very high level (≥96% or 100%). Only the "adjuvant cisplatin-based chemotherapy" indicator showed declining values between 2018 and 2020. The target values and plausibility limits were well achieved by LCC. After updating the guideline, one QI from 2018 was not included in the new QI set due to the small denominator population. Based on the new strong recommendations, 8 new QIs were defined. From the QI set of the guideline update, 13 of 15 indicators (7 since 2018 and 6 from 2022 on) were adopted into the certification program. CONCLUSIONS The guideline recommendations are implemented by LCC at a high level. The process presented confirms the successful implementation of the so-called quality cycle in oncology. The QIs developed by the German Guideline Program in Oncology (GGPO) are adopted by the certification program. The implementation of the QI is measured in LCC, evaluated by the German Cancer Society (DKG), and reflected back to the GGPO. The "real world" data have led to the deletion of one QI and show a high implementation of most QIs in LCC.
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Affiliation(s)
- Martin Utzig
- Zertifizierung, Deutsche Krebsgesellschaft e.V., Berlin, Germany
| | - Hans Hoffmann
- Division of Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Niels Reinmuth
- Thorakale Onkologie, Asklepios Fachkliniken München-Gauting, Gauting, Germany
| | - Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau gGmbH, Halle, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin, Germany
| | - Jessica Lobitz
- Wissensmanagement/Infonetz Krebs, Deutsche Krebsgesellschaft e.V., Berlin, Germany
| | - Johannes Rückher
- Zertifizierung, Deutsche Krebsgesellschaft e.V., Berlin, Germany
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Lehmann L, Appelbaum S, Ostermann T, Weber B, Hofmann SC. Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004 to 2018. J Dtsch Dermatol Ges 2022; 20:1603-1611. [PMID: 36464811 DOI: 10.1111/ddg.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Assessment of complaints addressed to the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association helps to identify quality assurance problems in dermatology. METHODS 333 dermatological reports (years 2004-2018) were allocated to three five-year intervals in order to show changes of total number of reports and with regard to indications, types of care, defined diagnosis categories, and therapeutic interventions. Statistical analysis was mainly descriptive (SPSS 27). Representative cases are explained in more detail. RESULTS The number of dermatological reports fell from 119 in the first to 92 reports in the last five-year interval, along with a decline in treatment error rates (43 % and 29 %) despite an increasing number of procedures across disciplines. 104 reports dealt with (supposed) diagnostic errors, 156 with physical or pharmacological therapies, and 73 reports with surgery. The latter had a low treatment error rate (29 %). CONCLUSIONS In comparison to the number of dermatological treatments in Germany, patient allegations are raised only rarely indicating greater patient satisfaction and/or a lower risk potential in dermatology. Incorrect dosages or device settings, diagnostic errors, and deficits in obtaining informed consent are relevant sources of error as underlined by the presented case reports.
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Affiliation(s)
- Lion Lehmann
- Institute of General Medicine, University Hospital Cologne, Cologne, Germany.,Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Sebastian Appelbaum
- Department of Psychology and Psychotherapy, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Beate Weber
- Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association, Düsseldorf, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology und Dermatosurgery, University of Witten/Herdecke, Helios University Hospital Wuppertal, Wuppertal, Germany
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Jobson D, Roffey B, Arnold C, Azzi A, Button-Sloan A, Dawson T, Fernandez-Penas P, Fishburn P, Gyorki DE, Hiscutt EL, Jakrot V, Lilleyman A, Lochhead A, Long GV, Mailer S, Mann G, McCormack CJ, Muir J, Pratt GF, Scolyer RA, Shackelton M, Shumack S, Soyer HP, Tan CG, Webb A, Zalcberg J, Morton R, Mar V. Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study. Australas J Dermatol 2022; 63:344-351. [PMID: 35486539 DOI: 10.1111/ajd.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty-six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. METHODS Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two-round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. RESULTS Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. CONCLUSION This study provides a multi-stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).
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Affiliation(s)
- Dale Jobson
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Roffey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Arnold
- Hodgson Associates, Melbourne, Victoria, Australia.,Biogrid Australia, Parkville, Victoria, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, New South Wales, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Skin Cancer Institute, Singapore City, Singapore.,Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | | | - Tamara Dawson
- Melanoma and Skin Cancer Advocacy Network, Carlton, Victoria, Australia
| | - Pablo Fernandez-Penas
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Paul Fishburn
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Norwest Skin Cancer Centre, New South Wales, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma L Hiscutt
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | - Alister Lilleyman
- Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | - Alistair Lochhead
- Southern IML Pathology, Wollongong, New South Wales, Australia.,Department of Anatomical Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Mater Hospital, Sydney, New South Wales, Australia
| | - Sonia Mailer
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Melanoma Research Victoria, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher J McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jim Muir
- University of Queensland, Brisbane, Queensland, Australia.,Mater Hospital, Brisbane, Queensland, Australia
| | - George F Pratt
- Plastic and Reconstructive Unit, Monash Health, Dandenong, Victoria, Australia.,Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackelton
- Central Clinical School and School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Department of Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Stephen Shumack
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Skin Health Institute, Carlton, Victoria, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Rachael Morton
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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