Are Quality Indicators for Radiotherapy Useful in the Evaluation of Service Efficacy in a New Based Radiotherapy Institution?

Abstract

Aims and background A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service ( Istituto Superiore di Sanità) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit. Patients and methods The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction). Results The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 ± 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 ± 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 ±10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance. Conclusions The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results.

Narrative synthesis of health service accreditation literature

“…Other examples of organisational indices used to examine accreditation impacts within the literature include: provision of family counselling;55 leadership and staff involvement;38 staff to patient ratios and waiting times;57 and information management and leadership 30…”

“…A total of 42 studies examined the development and impacts of accreditation programmes 3 6 21 25 26 29–31 51 54 55 57 59–61 64 66 70 71 73 75 80–82 84 86 88 93 96 98 100–109 122 128. A combination of positive, negative and neutral impacts were identified (see table 4).…”

An effectiveness analysis of healthcare systems using a systems theoretic approach

“…Under the present conditions, studies of the efficacy of quality measurement and reporting systems in stimulating quality improvement show mixed results. Some quality measures have been shown to have a positive impact on quality improvement [ 6 , 40 - 42 ]. In particular, the reporting systems linked to payment, accreditation, and peer pressure from public benchmarking have made quality measurement and improvement higher priorities for hospital leadership and achieved better results [ 42 ].…”

Determinantes da qualidade na radiologia oncológica

“…Embora a maioria dos IQ relevantes para a radiologia oncológica tenham sido específicos da doença, houveram algumas tentativas para definir IQs gerais para a prática de radiologia oncológica. Um grupo italiano desenvolveu 13 IQ para radiologia oncológica (CIONINI et al, 2007) e os pesquisadores posteriormente demonstraram viabilidade na coleta de dados sobre esses indicadores para avaliação a nível de departamento (GABRIELE et al, 2006). Foram identificados vários indicadores generalizáveis: integridade dos dados de registro médico, porcentagem de casos discutidos em um ambiente multidisciplinar, uso de planejamento de tratamento baseado em tomografia computadorizada, frequência de verificação do portal filme de tratamento, medidas de adequação de controle de qualidade física e satisfação do paciente (CIONINI et al, 2007).…”