!Aim: Certification of breast centers helps improve the quality of care but requires additional resources, particularly for documentation. There are currently no published data on the actual staff costs and financial resources required for such documentation. The aim of this study was to determine the time and resources required to document a patient with primary breast cancer from diagnosis to the end of follow-up, to establish a database for future strategic decisions. Material and Methods: All diagnostic and therapeutic procedures of patients with primary breast cancer were recorded at the University Breast Center of Franconia. All time points for documentation were evaluated using structured interviews. The times required to document a representative number of patients were determined and combined with the staff costs of the different professional groups, to calculate the financial resources required for documentation. Results: A total of 494 time points for documentation were identified. The study also identified 21 departments and 20 different professional groups involved in the documentation. The majority (54 %) of documentation was done by physicians. 62 % of all documentation involved outpatients. The results of different scenarios for the diagnosis, therapy and follow-up of breast cancer patients in a certified breast center showed that the time required for documentation can be as much as 105 hours, costing € 4135. Conclusion: This analysis shows the substantial staffing and financial costs required for documentation in certified centers. A multi-center study will be carried out to compare the costs for certified breast centers of varying sizes with the costs of non-certified care facilities. Zusammenfassung

Background: The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods: The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results: For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion: The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.

Zusammenfassung Fragestellung: Die Tumordokumentation ist f?r Qualit?tssicherung onkologischer Behandlungen sowie als Quelle zuverl?ssiger Information ?ber die sektor?bergreifende Versorgung essentiell. Am Beispiel der Mammakarzinomerkrankung wird untersucht, welcher Dokumentationsaufwand und damit verbundener Ressourcenverbrauch besteht. Material und Methoden: Die Versorgungskette bei?Patientinnen mit prim?rem Mammakarzinom in standardisierter Erkrankungssituation wurde von initialer Diagnostik bis Abschluss der Nachsorge definiert. Nach Pilotphase erfolgte mit Unterst?tzung des Bundesgesundheitsministeriums eine multizentrische Validierung (n=7 Zentren). Die Dokumentationszeitpunkte wurden horizontal erhoben und mit L?nge und Personalaufwand erfasst. Ergebnisse: Das ?rztliche Personal hat einen Anteil von 57?% der Dokumentationskosten. Je nach Klinik bzw. Zentrum entstehen Kosten von 352,82?bis 1?084,08?? f?r den Gesamtablauf der Behandlung von Erstdiagnose bis Abschluss der Nachsorge. In nicht-zertifizierten Zentren zeigt sich ein reduzierter Aufwand und somit geringere Kosten. Schlussfolgerungen: Die Ergebnisse zeigen die Notwendigkeit der Reduktion des Dokumentationsaufwandes ? insbesondere f?r die ?rztliche Profession, die kostenintensivste Berufsgruppe im Gesundheitswesen. Da von einer Qualit?tsverbesserung durch die Zertifizierung mit ihren speziellen Anforderungen auszugehen ist, ergibt sich die Forderung nach einer ad?quaten Verg?tung f?r die Dokumentation. Des Weiteren ist es erforderlich eine reduzierte Anzahl an Variablen f?r die Qualit?tssicherung zentral festzulegen und eine fl?chendeckende berufs?bergreifende Dokumentation zu erreichen. Investitionen in einen einheitlichen Datensatz und in Schnittstellenoptimierungen der vorhandenen Dokumentationssysteme sollten erfolgen.

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