Quality assurance and improvement in oncology using guideline-derived quality indicators –results of the Gynaecological Cancer Centers certified by the German Cancer Society (DKG)

Abstract Purpose: On the example of Gynaecological Cancer Centres (GCCs) certified by the German Cancer Society, this study evaluates results of medical guideline derived quality indicators (QIs) for cervical cancer (CC) and ovarian cancer (OC), examines how implementation of the indicators developed over the course-of-time, status of the guideline-compliant-care and identifies improvement measures.Methods: QI results for patients with CC and OC treated in GCCs between 2015-2019 are analysed. The QIs median, overall proportion and standard deviation were calculated. Two-sided Cochran-Armitage tests were applied.Results: QIs are divided in 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 application. PO-QIs have tremendous influence on the quality of care, while being easy implementable 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-reasons meaningfully prevent further increase. TP-QIs that report on surgical interventions fluctuate. 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.Conclusion: The analysis shows that a combination of different measures is necessary to anchor quality sustainably in health care and thus improve it.