1
|
Radtke JP, Albers P, Hadaschik BA, Graefen M, Meyer CP, Behr B, Nüesch S. Value-Based Health Care for Prostate Cancer Centers by Implementing Specific Key Performance Indicators Using a Balanced Score Card. Healthcare (Basel) 2024; 12:991. [PMID: 38786402 PMCID: PMC11121431 DOI: 10.3390/healthcare12100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/20/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in men in 112 countries, and accounts for 15% of cancers. Because it cannot be prevented, the rise in cases is inevitable, and improvements in diagnostic pathways and treatments are needed, as there is still a shortage of cost-effective diagnostics and widespread oncologically safe treatment options with measurable quality. As part of the implementation of a Full Cycle of Care, instruments have been developed to achieve value-based medicine, such as consistent commitment to measurability. One of these instruments is the Balanced Scorecard (BSC). Here, we propose the first BSC for prostate cancer (PC) treatment. METHODS BSCs are used to assess performance in healthcare organizations across four dimensions: financial, patient and referrer, process, and learning and development. This study aimed to identify Key Performance Indicators (KPIs) for each perspective. A systematic literature search was conducted according to PRISMA guidelines using multiple databases and specific search terms to identify KPIs for PC care, excluding case reports and conference abstracts. In total, 44 reports were included in analyses and development of the PC-specific BSC. RESULTS In the present study, a PC-specific BSC and KPIs were defined for the four classic perspectives, as well as for a newly developed PC-Specific Disease and Outcome perspective, including patient-related parameters from the German Cancer Society and the International Consortium for Health Outcomes Measurement. In addition, the Process perspective includes KPIs of fulfillment of continuing education of residents and the metrics of structured training of the radical prostatectomy procedure in the Learning and Development perspective. CONCLUSIONS The developed BSC provides a comprehensive set of perspectives for an Integrated Practice Unit or center in PC care, ensuring that the indicators remain manageable and applicable. The BSC facilitates value creation in line with Porter's Full Cycle of Care by systematically collecting and providing economic, personnel, and medical results, actions, and indicators. In particular, this BSC includes KPIs of structured training of practitioners and metrics of the German Cancer Society, that recently proved to improve PC patients outcomes.
Collapse
Affiliation(s)
- Jan Philipp Radtke
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany;
- Department of Radiology, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany;
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (dkfz), 69120 Heidelberg, Germany
| | - Boris A. Hadaschik
- Department of Urology, University of Duisburg-Essen, 45147 Essen, Germany;
- German Cancer Consortium (dktk), University Hospital Essen, 45147 Essen, Germany
| | - Markus Graefen
- Martini Clinic, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Christian P. Meyer
- Department of Urology, Klinikum Herford, University Hospital of Ruhr-University, 44789 Herford, Germany;
| | - Björn Behr
- Department of Plastic and Hand Surgery, BG-University Hospital Bergmannsheil Ruhr University Bochum, 44789 Bochum, Germany;
| | - Stephan Nüesch
- Center for Management, School of Business and Economics, University of Muenster, 48149 Muenster, Germany;
- International Institute of Management in Technology, University of Fribourg, 1700 Fribourg, Switzerland
| |
Collapse
|
2
|
Baeten IGT, Hoogendam JP, Schreuder HWR, Jürgenliemk-Schulz IM, Gerestein CG, Zweemer RP. Introducing a novice surgeon to an experienced robotic gynaecological oncology team: An observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery. Gynecol Oncol 2023; 178:153-160. [PMID: 37865051 DOI: 10.1016/j.ygyno.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To evaluate the effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team treating cervical cancer patients. METHODS Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019 were retrospectively included. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all 226 patients over three groups: early learning phase of 61 procedures without structured training (group 1), experienced phase of 104 procedures (group 2), and the 61 procedures during introduction of a novice with structured training (group 3). Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to assess the learning curve effect. Patient outcomes between the groups were compared. RESULTS Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 (p < 0.001) and similar to group 2 (p = 0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. CONCLUSIONS Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.
Collapse
Affiliation(s)
- Ilse G T Baeten
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Jacob P Hoogendam
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Henk W R Schreuder
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ina M Jürgenliemk-Schulz
- Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis G Gerestein
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
3
|
Lin PL, Zheng F, Shin M, Liu X, Oh D, D'Attilio D. CUSUM learning curves: what they can and can't tell us. Surg Endosc 2023; 37:7991-7999. [PMID: 37460815 PMCID: PMC10520215 DOI: 10.1007/s00464-023-10252-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/23/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION There has been increased interest in assessing the surgeon learning curve for new skill acquisition. While there is no consensus around the best methodology, one of the most frequently used learning curve assessments in the surgical literature is the cumulative sum curve (CUSUM) of operative time. To demonstrate the limitations of this methodology, we assessed the CUSUM of console time across cohorts of surgeons with differing case acquisition rates while varying the total number of cases used to calculate the CUSUM. METHODS We compared the CUSUM curves of the average console times of surgeons who completed their first 20 robotic-assisted (RAS) cases in 13, 26, 39, and 52 weeks, respectively, for their first 50 and 100 cases, respectively. This analysis was performed for prostatectomy (1094 surgeons), malignant hysterectomy (737 surgeons), and inguinal hernia (1486 surgeons). RESULTS In all procedures, the CUSUM curve of the cohort of surgeons who completed their first 20 procedures in 13 weeks demonstrated a lower slope than cohorts of surgeons with slower case acquisition rates. The case number at which the peak of the CUSUM curve occurs uniformly increases when the total number of cases used in generation of the CUSUM chart changes from 50 to 100 cases. CONCLUSION The CUSUM analyses of these three procedures suggests that surgeons with fast initial case acquisition rates have less variability in their operative times over the course of their learning curve. The peak of the CUSUM curve, which is often used in surgical learning curve literature to denote "proficiency" is predictably influenced by the total number of procedures evaluated, suggesting that defining the peak as the point at which a surgeon has overcome the learning curve is subject to routine bias. The CUSUM peak, by itself, is an insufficient measure of "conquering the learning curve."
Collapse
Affiliation(s)
- Peng-Lin Lin
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA.
| | - Feibi Zheng
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA
| | - Minkyung Shin
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA
| | - Xi Liu
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA
| | - Daniel Oh
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA
| | - Daniel D'Attilio
- Intuitive Surgical, 1020 Kifer Road, Sunnyvale, CA, 94086-5304, USA
| |
Collapse
|
4
|
Kato D, Namiki S, Ueda S, Takeuchi Y, Takeuchi S, Kawase M, Kawase K, Nakai C, Takai M, Iinuma K, Nakane K, Koie T. Validation of standardized training system for robot-assisted radical prostatectomy: comparison of perioperative and surgical outcomes between experienced surgeons and novice surgeons at a low-volume institute in Japan. MINIM INVASIV THER 2022; 31:1103-1111. [PMID: 35352619 DOI: 10.1080/13645706.2022.2056707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although robot-assisted radical prostatectomy (RARP) has become a standard treatment modality in patients with prostate cancer (PCa), RARP is a complicated and difficult surgical procedure due to the risk of serious surgery-related complications. This study aimed to evaluate the validation of a standardized training system for RARP in patients with PCa at a single institute. MATERIAL AND METHODS We retrospectively reviewed the clinical and pathological records of 155 patients with PCa who underwent RARP at Gifu University between August 2018 and April 2021. We developed an institutional program for new surgeons based on the separation of the RARP procedure into six checkpoints. The primary endpoints were surgical outcomes and perioperative complications among three groups (expert, trainer, and novice surgeon groups). RESULTS The console time was significantly longer in the novice surgeon group than in the other groups. Regarding bladder neck dissection, ligation of lateral pedicles, and vesicourethral anastomosis, the operative time was significantly shorter in the expert group than in the other groups. Surgery-related complications occurred in 15 patients (9.7%). CONCLUSIONS Our training system for RARP might help reduce the influence of the learning curve on surgical outcomes and ensure that the surgeries performed at low-volume institutions are safe and effective.
Collapse
Affiliation(s)
- Daiki Kato
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Sanae Namiki
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Shota Ueda
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | | | - Shinichi Takeuchi
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Kota Kawase
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Chie Nakai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Manabu Takai
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Koji Iinuma
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Keita Nakane
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| | - Takuya Koie
- Department of Urology, Gifu Graduate School of Medicine, Gifu, Japan
| |
Collapse
|