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

Wallwiener M, Brucker SY, Wallwiener D, Steering Committ - Arch. Gynecol. Obstet. (2012)

Bottom Line: Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University of Heidelberg, Voßstraße 9, 69115 Heidelberg, Germany. markus.wallwiener@googlemail.com

ABSTRACT

Purpose: This 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.

Methods: Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes.

Results and conclusions: Improvements 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.

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Relative 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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Fig1: Relative 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

Mentions: Figure 1 shows the changes in relative performance over time for all quality indicators for which the DKG/DGS Requirements of Breast Centres (FAB) specified performance levels for the third year of certification. Relative performance of each quality indicator is expressed as a percentage of the respective third-year requirement.Fig. 1


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

Wallwiener M, Brucker SY, Wallwiener D, Steering Committ - Arch. Gynecol. Obstet. (2012)

Relative 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
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351617&req=5

Fig1: Relative 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
Mentions: Figure 1 shows the changes in relative performance over time for all quality indicators for which the DKG/DGS Requirements of Breast Centres (FAB) specified performance levels for the third year of certification. Relative performance of each quality indicator is expressed as a percentage of the respective third-year requirement.Fig. 1

Bottom Line: Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, University of Heidelberg, Voßstraße 9, 69115 Heidelberg, Germany. markus.wallwiener@googlemail.com

ABSTRACT

Purpose: This 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.

Methods: Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes.

Results and conclusions: Improvements 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.

Show MeSH
Related in: MedlinePlus