Indicators to evaluate quality of care in head and neck cancer in Spain

PURPOSE

This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC).

METHODS

A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators.

RESULTS

We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment.

CONCLUSIONS

We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.

Measures to evaluate quality of care in head and neck cancer: Results of a Delphi study

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Background: Currently, no specific measures are used in Spain to evaluate quality of care in head and neck cancer, and programs such as the Quality Oncology Practice Initiative developed by the American Society of Clinical Oncology does not include head-and-neck-specific measures. Methods: A systematic literature review was carried out to identify measures useful for evaluating quality of care in head and neck cancer. A scientific committee, comprising 9 medical oncologists specialized in head and neck cancer, reviewed the literature findings and developed measures to be evaluated in a 2-step Delphi method. Experts in head and neck cancer practicing in Spain—specialized in medical oncology, radiotherapy oncology, maxillofacial surgery, pathology or otorhinolaryngology—participated in the Delphi, scoring the appropriateness of the measures using a 9-point Likert scale (1, extremely inappropriate; 9, extremely appropriate). Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category (1–3, 4–6, or 7–9) that encompassed the median score of the group. Results: Out of the 833 documents found with the literature review, 20 were selected from to identify measures of interest. Fifty measures, covering diagnosis (13), treatment (28), follow-up (5), and outcome (4), were evaluated with the Delphi method. The 52 Delphi participants reached consensus on the appropriateness of using all 50 measures to evaluate the quality of care in head and neck cancer. Measures with lowest scores concerned re-hospitalization shortly after surgery and long hospitalization after surgery. Measures with highest scores regarded the use of imaging for follow-up, a histology study prior to treatment, and complete resection of the tumor. The scientific committee then selected 29 measures based on their applicability and cost-effectiveness and developed index cards with definitions, formulas, acceptable level of attainment, and rationale for their use in clinical practice. Conclusions: The goal of this study was to develop measures to evaluate and improve the quality of care in head and neck cancer. These results show unanimous consensus from a group of experts on the proposed measures for diagnosis, treatment, follow-up, and outcome. The index cards developed with measures are easy to follow and their use could improve quality of care.

ECO Experts’ consensus on establishing renal cancer healthcare quality measures in Spain

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Background: The ECO Foundation (Excellence and Quality in Oncology) proposes to establish a set of healthcare quality measures (including indicators and standards) for the diagnosis, treatment and follow-up of renal cancer in Spain which all healthcare professionals involved can assume, being suitable for implementation in the continuous improvement process of our healthcare system. Methods: a) International literature review on the quality of healthcare in renal cancer; b) multidisciplinary driving group (9 oncologists with expertise in renal cancer plus 2 methodologists) to identify and choose possible quality measures to be applied in Spain; c) global evaluation of the relevance of these measures through experts’ consensus (Delphi modified by a stratified state panel, n = 55 oncologists specialized in renal cancer); d) selection of definitive measures, according to their feasibility and efficiency (information provided/effort in obtaining it) using a quantitative online priority grid; e) standard wording of the chosen measures: definition, indicator, sources of information, exclusions, clarifications, categorization and acceptable standard. Results: The nominal group proposed 43 quality measures for the Delphi panel. Consensus agreement rate = 84.5% (47/55). The professional consensus was reached on 40 measures (4 structural, 33 in healthcare procedures and 3 in clinical results). Therefore, there is a high level of consensus (93%) among Spanish oncologists who specialize in renal cancer on the content of the healthcare quality measures in the management of renal cancer. The final measures were chosen using a high confidence level (95%) in the unanimity of the experts (oncologists in the driving group) for prioritization depending on the feasibility and efficiency in the healthcare system. Finally, 25 measures were chosen (2 structural, 20 in procedures and 3 in results). Conclusions: The level of consensus and prioritization of measures achieved, will most likely translate in a widespread acceptance and viability for implementation in the National Health System. This could provide a valuable tool for quality assessment and equality in the care of renal cancer patients in Spain.