Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results 2003–2007 from Germany as a proof of conceptReport as inadecuate

Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results 2003–2007 from Germany as a proof of concept - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 8:358

First Online: 02 December 2008Received: 25 June 2008Accepted: 02 December 2008DOI: 10.1186-1471-2407-8-358

Cite this article as: Brucker, S.Y., Schumacher, C., Sohn, C. et al. BMC Cancer 2008 8: 358. doi:10.1186-1471-2407-8-358


BackgroundThe main study objectives were: to establish a nationwide voluntary collaborative network of breast centres with independent data analysis; to define suitable quality indicators QIs for benchmarking the quality of breast cancer BC care; to demonstrate existing differences in BC care quality; and to show that BC care quality improved with benchmarking from 2003 to 2007.

MethodsBC centres participated voluntarily in a scientific benchmarking procedure. A generic XML-based data set was developed and used for data collection. Nine guideline-based quality targets serving as rate-based QIs were initially defined, reviewed annually and modified or expanded accordingly. QI changes over time were analysed descriptively.

ResultsDuring 2003–2007, respective increases in participating breast centres and postoperatively confirmed BCs were from 59 to 220 and from 5,994 to 31,656 > 60% of new BCs-year in Germany. Starting from 9 process QIs, 12 QIs were developed by 2007 as surrogates for long-term outcome. Results for most QIs increased. From 2003 to 2007, the most notable increases seen were for preoperative histological confirmation of diagnosis 58% in 2003 to 88% in 2007, appropriate endocrine therapy in hormone receptor-positive patients 27 to 93%, appropriate radiotherapy after breast-conserving therapy 20 to 79% and appropriate radiotherapy after mastectomy 8 to 65%.

ConclusionNationwide external benchmarking of BC care is feasible and successful. The benchmarking system described allows both comparisons among participating institutions as well as the tracking of changes in average quality of care over time for the network as a whole. Marked QI increases indicate improved quality of BC care.

AbbreviationsAGOArbeitsgemeinschaft Gynäkologische Onkologie DGGG Working Group on Gynaecological Oncology

BCTbreast-conserving therapy

BCbreast cancer

DGGGDeutsche Gesellschaft für Gynäkologie und Geburtshilfe German Society of Obstetrics and Gynaecology

DFSdisease-free survival

DGSDeutsche Gesellschaft für Senologie German Society of Senology

DKGDeutsche Krebsgesellschaft German Cancer Society

DOCDeutsches Onkologie Centrum Holding GmbH German Oncology Centre Ltd.

EUSOMAEuropean Society of Breast Cancer Specialists formerly: of Mastology

FABFachliche Anforderungen an Brustzentren Requirements of Breast Centres

HER-2-neuhuman epidermal growth factor receptor 2

PQIprocess quality indicator

QAquality assurance

QIquality indicator

SQLstructured query language

WBCWestdeutsches Brust-Centrum West German Breast Centre

XMLextensible markup language.

For full list, see Acknowledgements

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-8-358 contains supplementary material, which is available to authorized users.

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Author: Sara Y Brucker - Claudia Schumacher - Christoph Sohn - Mahdi Rezai - Michael Bamberg - Diethelm Wallwiener - the Steering C


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