Hellerhoff K
Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
Radiologe. 2011 Oct;51(10):868-75. doi: 10.1007/s00117-011-2164-4.
The primary focus of the establishment and certification of specialized cancer centers in the context of the National Cancer Plan is to improve the quality of care for patients with various carcinoma entities. The era of organ center certification started with the establishment of specialized breast cancer centers in line with the high incidence of breast cancer, the high mortality rate and the high level of interdisciplinary cooperation in the diagnosis and therapy of breast cancer. The introduction of quality management and external monitoring aims to provide high quality care in the diagnosis and therapy of breast cancer and is expected to improve long-term quality data (disease-free survival and overall survival) and to reduce mortality rates by about 25-30%. Certification requires the implementation of a quality management system and care provision structures assuring diagnosis and therapy according to the quality guidelines and recommendations of the specialist societies. Basic requirements for improving the quality of breast cancer patient care are centralization, specialization and interdisciplinarity. It has been demonstrated that the improvement of overall survival is associated with an increasing annual case load of a center, an increasing case load per surgeon per year, study participation and interdisciplinarity. Tumor documentation will be harmonized in the future by the establishment of local clinical cancer registries and cross-linking them with the National Cancer Registry. The data collection and analysis of several quality markers and current follow-up and survival data for each breast cancer patient will allow direct comparison of participating institutions. Individual breast cancer centers may demonstrate quality improvement longitudinally. Both certification and specialization require additional services which are associated with a substantial increase in costs. Preliminary data suggest that certified breast cancer centers are dependent on cross-financing by the participating departments of a hospital. Up to now cost-effective analyses for certified breast cancer centers are not available due to a substantial lack of data defining the additional financial burden.
在国家癌症计划背景下，设立和认证专业癌症中心的主要重点是提高各类癌症患者的护理质量。器官中心认证时代始于随着乳腺癌的高发病率、高死亡率以及乳腺癌诊断和治疗中的高度跨学科合作而设立的专业乳腺癌中心。质量管理和外部监测的引入旨在为乳腺癌的诊断和治疗提供高质量护理，并有望改善长期质量数据（无病生存期和总生存期），并将死亡率降低约25%至30%。认证要求实施质量管理体系和护理提供结构，以确保根据专业学会的质量指南和建议进行诊断和治疗。提高乳腺癌患者护理质量的基本要求是集中化、专业化和跨学科性。已经证明，总生存期的改善与中心每年病例数的增加、每位外科医生每年病例数的增加、研究参与度和跨学科性相关。未来，通过建立地方临床癌症登记处并将其与国家癌症登记处交联，肿瘤记录将得到统一。对每位乳腺癌患者的多个质量指标以及当前随访和生存数据进行数据收集和分析，将使参与机构能够进行直接比较。各个乳腺癌中心可以纵向展示质量改善情况。认证和专业化都需要额外的服务，这会带来成本的大幅增加。初步数据表明，认证的乳腺癌中心依赖于医院参与部门的交叉融资。由于严重缺乏定义额外财务负担的数据，目前尚无针对认证乳腺癌中心的成本效益分析。
