Development and Update of Guideline-based Quality Indicators in Lung Cancer

Abstract

Background In 2022, an update of the German lung cancer guideline, first published in 2010 and revised in 2018, was released. This article aims to show the process of updating, developing, and implementing guideline-based quality indicators (QI) into the certification system for lung cancer centers (LCC).

Methods A multidisciplinary and interprofessional working group revised the guideline QIs from 2018 using the strong recommendations of the guideline update, a systematic review for QIs, and the results of the implemented QIs from LCC.

Results For 4 out of 8 indicators from the 2018 guideline, the LCC showed an improved implementation of the requirements in the last 3 years (2018–2020). For 3 indicators, the median of the results was constant at a very high level (≥96% or 100%). Only the “adjuvant cisplatin-based chemotherapy” indicator showed declining values between 2018 and 2020. The target values and plausibility limits were well achieved by LCC. After updating the guideline, one QI from 2018 was not included in the new QI set due to the small denominator population. Based on the new strong recommendations, 8 new QIs were defined. From the QI set of the guideline update, 13 of 15 indicators (7 since 2018 and 6 from 2022 on) were adopted into the certification program.

Conclusions The guideline recommendations are implemented by LCC at a high level. The process presented confirms the successful implementation of the so-called quality cycle in oncology. The QIs developed by the German Guideline Program in Oncology (GGPO) are adopted by the certification program. The implementation of the QI is measured in LCC, evaluated by the German Cancer Society (DKG), and reflected back to the GGPO. The “real world” data have led to the deletion of one QI and show a high implementation of most QIs in LCC.

Zusammenfassung

Hintergrund Die 2010 erstmals publizierte und 2018 überarbeitete deutsche S3-Leitlinie Lungenkarzinom (LL) wurde 2022 aktualisiert. Ziel dieses Artikels ist es, den Prozess der Aktualisierung und Entwicklung der auf den starken Empfehlungen der Leitlinie basierenden Qualitätsindikatoren (QI) und die Implementierung dieser QI in das Zertifizierungssystem für Lungenkrebszentren (LZ) darzustellen.

Methoden Nach systematischem Review überarbeitete eine multidisziplinäre und interprofessionelle Arbeitsgruppe unter Berücksichtigung der QI-Ergebnisse der zertifizierten LZ und auf Grundlage der starken Empfehlungen des LL-Updates die Leitlinien-QI aus dem Jahr 2018.

Ergebnisse Die LZ haben in den letzten 3 Jahren (2018–2020) ihre Ergebnisse für 4 von 8 Indikatoren (LL 2018) verbessert. Bei 3 Indikatoren ist der Median der Ergebnisse auf einem sehr hohen Niveau (≥96% oder 100%) konstant. Lediglich der Indikator „Adjuvante Cisplatin-basierte Chemotherapie“ weist zwischen 2018 und 2020 rückläufige Werte auf. Die Sollvorgaben und Plausibilitätsgrenzen werden von den LZ gut erreicht. Nach der Aktualisierung der Leitlinie wurde ein QI (LL-2018) aufgrund eines kleinen Patientenkollektivs nicht in das neue QI-Set aufgenommen. Basierend auf den neuen starken Empfehlungen wurden 8 neue QI definiert. Aus dem QI-Set der Leitlinienaktualisierung sind 13 von 15 Indikatoren (7 seit 2018 und 6 weitere ab 2022) in das Zertifizierungsprogramm aufgenommen worden.

Schlussfolgerungen Die Empfehlungen der Leitlinie werden von den LZ auf hohem Niveau umgesetzt. Der dargestellte Prozess bestätigt die erfolgreiche Umsetzung des sog. Qualitätszyklus in der Onkologie: Die vom Leitlinienprogramm Onkologie (OL) entwickelten QI werden in das Zertifizierungsprogramm übernommen. Die Umsetzung der QI wird in den LZ gemessen, von der Deutschen Krebsgesellschaft (DKG) bewertet und an das OL zurückgespiegelt. Die „real-world“-Daten haben zur Streichung eines QI geführt und zeigen in den zertifizierten Lungenkrebszentren eine hohe Umsetzung der meisten QI.

Keywords

lung cancer - quality indicators - key figures - quality of care - guideline

Schlüsselwörter

Lungenkarzinom - Qualitätsindikatoren - Kennzahlen - Versorgungsqualität - Leitlinie

Publication History

Received: 29 August 2023

Accepted after revision: 03 November 2023

Article published online:
11 December 2023

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