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

Abstract

PurposeThis 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.MethodsReview and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes.Results and conclusionsImprovements 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.

The effect of EUSOMA certification on quality of breast cancer care

“…, A Costa (7), M Danei (9), A Denk (10), G Emons (11), K Friedrichs (12), N Harbeck (13), M Kiechle (14), U Koheler (15), S Kuemmel (16), N. Maass (8), C. Marth (17), A Prové (18), R. Kimmig (19), C Rageth (20), L Regolo (21), L Salehi (22), D Sarlos (23), C Singer (24), C Sohn (4), G Staelens (25), C Tinterri (26) …”

Benchmarking specialty hospitals, a scoping review on theory and practice

“…Feedback from stakeholders and availability of information was used to develop indicators. A final questionnaire, containing 17 questions, was send to thirty pediatric surgery practices.N.A.Quantitative outcome indicatorsA review of the clinical revenue performance of the practice illustrates that pediatric surgeons are unable to generate sufficient direct financial resources to support their employment and practice operational expenses.The value of the services must accrue to a second partyN.A.Van Vliet [23]A retrospective comparative benchmark study with a mixed-method designPartner: Industry/GlobalContent: StrategicPurpose: CollaborativeThe method comprised of 6 steps: (1) operational focus; (2) autonomous work cell; (3) physical lay-out of resources; (4) multi-skilled team; (5) pull planning and (6) elimination of wastes.N/AThe environmental context and operational focus primarily influenced process design of the cataract pathways.When pressed to further optimize their processes, hospitals can use these systematic benchmarking data to decrease the frequency of hospital visits, lead times and costs.N.A.Wallwiener [25]Review of existing literature/data.Partner: IndustryContent: PerformancePurpose: CollaborativePhase 1: Benchmarking; Phase 1a: proof of principle: Develop quality indicators; Phase 1b: analysis for a single specific specialty: to demonstrate the feasibility of subgroup analysis. Phase 2: certification of breast centres: to implement a quality management system to assess structural, process and outcome quality.Phase 3: nationwide implementation of certified breast centres.Structural and process indicatorsThe voluntary benchmarking programme has gained wide acceptance among DKG/DGS-certified breast centres.…”

“…Setoguchi et al [24] used a combination of prospective and retrospective designs. Existing literature was used in two studies [25, 26]. More information on study design can be found in Table 3.…”

“…case management and length of stay; and Chung et al [17] used structure, process and outcome indicators. One study [20] used a mixture of process and outcome indicators, while another study [25] used a combination of structural and process indicators. Most studies used quantitative indicators, such as 5-year over-all survival rate [17].…”

“…The goal of establishing a nationwide network of certified breast centres in Germany can be considered largely achieved according to Wallwiener [25]. Wesselman [26] shows that most of the targets for indicators for colorectal care are being better met over the course of time.…”