Charité-University Hospital Berlin, Berlin, Germany.
German Cancer Society e.V., 14057, Berlin, Germany.
J Cancer Res Clin Oncol. 2023 May;149(5):1703-1715. doi: 10.1007/s00432-022-04060-8. Epub 2022 Jun 3.
Based on the example of Gynaecological Cancer Centres (GCCs) certified by the German Cancer Society, this study evaluates the results of medical-guideline-derived quality indicators (QIs) for cervical cancer (CC) and ovarian cancer (OC), examines the development of indicator implementation over time as well as the status of guideline-compliant care and identifies improvement measures.
QI results for patients with CC and OC treated in GCCs between 2015 and 2019 are analysed. The median, overall proportion and standard deviation of each QI were calculated. Two-sided Cochran-Armitage tests were applied.
QIs are divided into two categories: process-organization (PO-QIs) and treatment-procedures (TP-QIs), to allow a differentiated analysis for identifying improvement measures. PO-QIs that reflect the implementation of processes and structures show a high degree of application. PO-QIs have a tremendous influence on the quality of care and are easy to implement through SOPs. TP-QIs report on treatments that are performed in the GCC. TP-QIs that report on systemic therapies reach a plateau where the guideline is known, but patient-related-factors meaningfully prevent further increase. TP-QIs that report on surgical interventions fluctuate. The most relevant factors are practitioners' personal skills. Besides the discussion of results amongst peers during the audit, improvement measures could include surgical courses or coaching.
The analysis shows that a combination of different measures is necessary to anchor quality sustainably in health care and thus improve it.
本研究以德国癌症协会认证的妇科癌症中心（GCC）为例，评估了基于医学指南的宫颈癌（CC）和卵巢癌（OC）质量指标（QI）的结果，考察了指标实施随时间的发展情况以及指南遵循性护理的现状，并确定了改进措施。
分析了 2015 年至 2019 年在 GCC 中治疗的 CC 和 OC 患者的 QI 结果。计算了每个 QI 的中位数、总体比例和标准差。应用了双侧 Cochran-Armitage 检验。
QI 分为两类：过程组织（PO-QI）和治疗程序（TP-QI），以允许进行差异化分析以确定改进措施。反映流程和结构实施的 PO-QI 具有高度的应用度。PO-QI 对护理质量有巨大影响，并且可以通过 SOP 轻松实施。报告 GCC 中进行的治疗的 TP-QI。报告全身治疗的 TP-QI 已经广为人知，但患者相关因素显著阻止了进一步的增加。报告手术干预的 TP-QI 波动。最相关的因素是从业者的个人技能。除了在审计期间同行之间讨论结果外，改进措施还可以包括手术课程或辅导。
分析表明，需要结合不同的措施才能将质量在医疗保健中持续稳定地固定下来，从而进行改进。
