147 Improvement in the quality of practices in radiotherapy: the regular measurement of indicators

Abstract

ContextFor several years, French comprehensive cancer centers (CCCs) have been committed to projects to improve security, quality and efficiency of radiotherapy. An improvement program in the radiotherapy departments of CCCs, including Professional Practice Appraisal, has been set up.ObjectivesThis campaign aims at improving quality of care in radiotherapy departments in all CCCs. It also anticipates the obligations binding institutions to obtain a radiation therapy agreement.The method is based on benchmarking:To establish a diagnosisTo share experiencesTo set up improvement projectsTo demonstrate the progress madeProgram13 quality indicators (QIs) have been developed with the participation of experts. They address treatment waiting times, multiprofessional treatment decision, treatment preparation, execution of treatment and follow-up. These QIs allow a qualitative assessment of the different steps in patient care.MethodIn each of the 20 CCCs, 80 medical records were included from patients treated by radiotherapy for a non inflammatory non metastatic breast cancer. Assessment could just been done on traceability, which is only indirectly related to quality of practice.To identify weaknesses and the corrective actions needed, each CCC analysed first its own QI measures from a local point of view and then in comparison with other centers. The corrective actions can be different from center to center depending on the anomalies and the ability to resolve them.Selected actions of improvement, according to a prioritisation process (costs, objectives and concerned professionals or departments), have been implemented. A schedule for these implementations was established in each CCC. Whenever possible, corrective actions and optimised processes were shared between the CCCs.ResultsThe results of the CCCs regarding these indicators show some heterogeneity in practices: the end treatment report and the post treatment consultation were available in 98% and in 93% of the medical records respectively. The rate of patient enrolment in clinical trials was 13%. The variability of these quality indicators between the 20 CCCs shows that they are discriminative. The fact that some teams obtained a 100% rate for different QIs reflects that this is achievable.ConclusionThe impact of this implementation campaign will be assessed one year after, using the same indicators. By defining such QIs we are able to follow programs for improving the quality and the security of treatment closely. The measurement of developed QIs allows us to improve the quality of patient care by improving management procedures. It encourages health care professionals to be aware of their practices and of the legal obligations. It also has the advantage of implicating all the professionals involved in patient care.ContexteDepuis plusieurs années les CLCC sont impliqués dans des travaux visant l'amélioration de la sécurité, de la qualité et de l'efficience, en radiothérapie.Un programme de renforcement de la qualité dans les départements de radiothérapie des 20 CL...

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“…Health systems are increasingly using quality indicators in radiation oncology, with waiting times being one of them, so waiting times should be as short as is reasonably achievable. 12 , 13 …”

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