Using the Delphi Technique to Improve Clinical Outcomes Through the Development of Quality Indicators in Renal Cell Carcinoma

Abstract

A systematic, consensus-based approach was used to determine relevant QIs in RCC care. These 23 QIs will provide a means of evaluating the quality of RCC care in an effort to improve outcomes in patients. The next step will be to establish a means of measuring each QI based on defined or yet-to-be-defined benchmarks.

Benchmarking quality for renal cancer surgery: Canadian Kidney Cancer information system (CKCis) perspective

“…10 To address this, the KCRNC developed a panel of process-focused QIs that span the spectrum of RCC care. 7 These process QIs define metrics that directly capture realworld care a patient receives and may be more actionable compared with outcome-or structure-based QIs. We have developed case-mix adjusted statistical models to benchmark hospital performance using the six KCRNC developed QIs for localized RCC.…”

“…7 These included the proportion of patients: 1) undergoing laparoscopic radical nephrectomy for T1-2 tumours (LA); 2) undergoing partial nephrectomy for T1 tumours (partial nephrectomy [PN]); 3) with risk factors for chronic kidney disease (CKD) undergoing partial nephrectomy (CKDPN) for T1 tumours, including those with hypertension, diabetes, or pre-existing CKD; 4) with a positive surgical margin (PMR) after partial nephrectomy for T1 tumours; 5) with a surgical complication following partial nephrectomy for T1 tumours (PNCx); and 6) the mean warm ischemia time (WIT) for patients undergoing partial nephrectomy for T1 tumours. For all QIs, we considered only patients who were metastasisfree at the time of surgery.…”

“…[4][5][6] To address this knowledge gap in renal cell carcinoma (RCC), the Kidney Cancer Research Network of Canada (KCRNC) developed a comprehensive list of QIs through a modified Delphi method, spanning the spectrum of RCC care from localized to metastatic disease. 7 Herein, we use the KCRNC QIs to benchmark hospital-level quality of care for localized RCC surgery at Canadian hospitals participating in the Canadian Kidney Cancer information system (CKCis), a national access-restricted database of RCC patients. …”

Causal variance decompositions for institutional comparisons in healthcare

“…This is commonly done in terms of disease-specific quality indicators (QIs) that measure structural, process or outcome elements related to the care of a particular condition [1]. For instance, in the context of surgical care for kidney cancer, examples would be (i) proportion of partial versus radical nephrectomies for early-stage patients with chronic kidney disease risk factors, (ii) proportion of minimally invasive versus open radical nephrectomies for early-stage patients, (iii) average length of stay after a radical nephrectomy or (iv) proportion of unplanned readmissions within 30 days of a radical nephrectomy [2]. Process measures may be preferred for measuring quality for the reason that they are directly related to clinical decisions and thus are more actionable [3].…”

Measuring Quality Care in Localized Renal Cell Cancer: Use of Appropriate Preoperative Investigations in a Population-Based Cohort

“…Quality indicators have been well-established for many malignancies; however, none had been established for rcc until recently. In 2013, a group of Canadian rcc experts used a modified Delphi approach to define 21 quality indicators across the entire disease spectrum 4 . One of those quality indicators is "obtaining appropriate preoperative risk specific staging investigations for localized rcc" 4 .…”