Optimizing the Quality of Breast Cancer Care at Certified German Breast Centers

Abstract

The current data confirm proof-of-concept for the established benchmarking program, which allows participating institutions to be compared and changes in quality of BC care to be tracked over time. Overall, marked QI increases suggest that BC care in Germany improved from 2003-2009. Moreover, it has become possible for the first time to demonstrate improvements in the quality of BC care longitudinally for individual breast centers. In addition, subgroups of relevant QIs can be used to demonstrate the progress achieved, but also the need for further improvement, in specific interdisciplinary specialties.

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

“…This was exemplified in a recent analysis of a subset of seven QIs of direct (QIs 9a, 9b, and 10) or indirect relevance to breast cancer radiotherapy [36]. The updated results of the subset analysis are summarized in Table 2, which shows that the QIs that directly reflect the guideline-concordance of radiotherapy (Nos.…”

“…To fill this gap, at least with regard to multidisciplinary breast centres, the first-ever prospective multicentre study investigating the implementation of a benchmarking programme at breast centres was conducted in Germany from 2003 to 2007 [35]. The study was subsequently extended until 2009 [36], and is still ongoing, the data for 2010 recently having become available [34]. …”

“…Relative performance of each quality indicator is expressed as a percentage of the respective third-year requirement.

Fig. 1Relative performance of quality indicators (QIs) during the 2003–2010 period, expressed as a percentage of the respective DKG/DGS Requirements of Breast Centres (FAB) for the third year of certification (modified from [36] and updated according to [34]). QIs: 1  = preoperative histological confirmation of diagnosis, 2a  = appropriate axillary dissection, 2b  = patients with sentinel lymph node biopsy (SLNB), ex-3  = complete tumour staging data, 3  = data on safety distance between tumour and resection margin, ex-4  = HER 2/neu assessment, 4  = specimen imaging; 5  = hormone receptor assessment, 6  = guideline-concordant endocrine therapy in hormone receptor-positive patients, ex-7.1a  = guideline-concordant adjuvant and neoadjuvant chemotherapy during the previous analysis period, age ≤70 years, 7.1a  = guideline-concordant adjuvant and neoadjuvant chemotherapy during the current analysis period, age ≤70 years, 7.2  = adjuvant combination chemotherapy with anthracyclines and/or taxanes, 8  = percentage of patients in clinical trials, 9a  = radiotherapy after breast-conserving surgery, 9b  = radiotherapy after breast-conserving surgery for ductal carcinoma in situ (DCIS), 10  = radiotherapy after mastectomy, 11b  = indication for breast-conserving therapy at T1

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Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery

“…or national level using a variety of methodologies can improve the quality of care of breast cancer patients but that this takes time [35-37]. According to the Dutch experience, none of 9 QIs met standards in 2002 whereas 4 did in 2008, with a significant improvement in all 9 QIs.…”

Controle Do Câncer De Mama Através Do Rastreamento Organizado Na Estratégia De Saúde Da Família

“…conclusão de duas visitas de acompanhamento com radioterapêuta no prazo de um ano e certificação do radioterapêuta. Esses pesquisadores descobriram que a adesão era geralmente alta para todos esses IQ, mas observou variação por localização geográfica, status socioeconômico e tipo de instalações de radioterapia(BEKELMAN et al 2011).Muitos estudos trabalharam na identificação de IQ para cuidados com câncer de mama(DESCH et al 2008;BRUCKER et al 2011), mas talvez o único dos IQ consistentemente identificado que seja diretamente aplicável à radiologia oncológica é o uso de radioterapia após cirurgia conservadora de mama. É discutível se esta métrica é válida para avaliar o radioterapêuta, uma vez que pode haver muitas razões para um paciente que não receber radioterapia após cirurgia conservadora de mama que estão fora do controle do radioterapêuta, incluindo o cirurgião que não encaminha o paciente para radioterapia ou o paciente que ter recusado a radioterapia (SMITH et al 2009…”