An economic evaluation of the optimal workload in treating surgical patients in a breast unit

Brucker

2012

Arch Gynecol Obstet

PurposeThis 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.MethodsReview and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes.Results and conclusionsImprovements 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.

Section: Discussionmentioning

confidence: 99%

Multidisciplinary breast centres in Germany: a review and update of quality assurance through benchmarking and certification

Brucker

2012

Arch Gynecol Obstet

“…To what extent the initially high costs of this new evidence-based standard and the associated quality management systems will be feasible Europe-wide and in what time frame, still remains to be clarified. An economic analysis by Pagano et al [44] estimated that to justify the economic investment, multidisciplinary breast cancer centres must achieve a minimum annual volume of 200 newly diagnosed cases of breast cancer. Similarly, EUSOMA also calls for an annual caseload of at least 150 newly diagnosed cases of primary breast cancer in order to ensure cost effectiveness and maintain the expertise of specialised multidisciplinary teams [8,9].…”

Section: Discussionmentioning

confidence: 99%

Certification of breast centres in Germany: proof of concept for a prototypical example of quality assurance in multidisciplinary cancer care

et al. 2009

BackgroundThe main study objectives were: to develop a set of requirements of comprehensive breast centres; to establish a nationwide voluntary certification programme for breast centres based on such requirements, a certified quality management system (QMS), and scheduled independent, external audits and periodic recertification; and to demonstrate the general acceptance of such a certification programme with a view to introducing similar certification programmes for other major cancers.MethodsBreast centres introduced a QMS and voluntarily participated in an external certification procedure based on guideline-derived Requirements of Breast Centres specifically developed for the application procedure, all subsequent audits and recertification. All data (numbers of pending and successful applications, sites/centre, etc.) were collected by a newly founded, independent organisation for certification of cancer services delivery. Data analysis was descriptive.ResultsRequirements of Breast Centres were developed by the German Cancer Society (DKG), the German Society of Senology (DGS) and other relevant specialist medical societies in the form of a questionnaire comprising 185 essential items based on evidence-based guidelines and the European Society of Breast Cancer Specialists' (EUSOMA) requirements of specialist breast units. From late 2002 to mid 2008, the number of participating breast centres rose from 1 to 175. As of mid 2008, 77% of an estimated 50,000 new breast cancers in Germany were diagnosed and treated at certified breast centres, 78% of which were single-site centres.ConclusionNationwide voluntary certification of breast centres is feasible and well accepted in Germany. Dual certification of breast centres that involves certification of breast services to guideline-derived requirements in conjunction with independent certification of a mandatory QMS can serve as a model for other multidisciplinary site-specific cancer centres.

“…So erscheint die Studie von Pagano et al [26] immer noch realistisch, nach der sich die Kosten-Erlös-Rechnung für "high quality breast cancer centers" mit der entsprechenden Spezialisierung und Multidisziplinarität sich erst ab mindestens 200 primären Mammakarzinomen pro Jahr als balanciert errechnen lässt. Dabei ist neben den geschilderten Fakten der höchste Kostenfaktor, der auch eine Flä-chendeckung auf diesem Niveau als sehr fraglich erscheinen lässt, der Kostenfaktor der ständigen Verfügbarkeit und Interaktion einer Multidisziplinarität.…”

Section: Zusammenfassende Wertungunclassified

“…durch eine Zentralisierung [26] verän-dert werden, auch der Anteil der brusterhaltenden Therapien [22]. Ein Review von Grilli et al [17] zeigte, dass es zu einem besseren operativen Management mit mehr brusterhaltenden Therapien und angepassteren Indikationen zu radikalen Operationen/Mastektomien kommt.…”

Section: Introductionunclassified

Zertifizierte multidisziplinäre Brustzentren

et al. 2010

Leitthema Das Mammakarzinom ist nach wie vor die häufigste maligne Tumor erkrankung der Frau. Nach Schät zungen des RobertKochInstituts er kranken in der Bundesrepublik jähr lich etwa 47.500 Frauen neu an Brust krebs [30], andere Quellen gehen von etwa 55.000 Neuerkrankungen aus [7, 13, 23]. Das mittlere Lebenszeit risiko beträgt in Deutschland 9,2%; es erkrankt somit durchschnittlich je de 11. Frau im Lauf ihres Lebens an Brustkrebs [30].Durch eine Reihe von Analysen gilt mittlerweile als gesichert, dass ei ne spezialisierte Teambildung und Zentralisierung in "Mammaschwer punkten" ("cancer units") zu einer Verbesserung der Therapie -und da mit des Outcome -des Mammakarzi noms führt, vorausgesetzt Qualitäts sicherung und management werden definiert und auch quantitativ über prüft (Benchmarking).