Benchmarking; Quality improvement; Quality indicators; Radiation oncology; Humans; Quality Improvement; Surveys and Questionnaires; Quality Indicators, Health Care; Hematology; Oncology; Radiology, Nuclear Medicine and Imaging
Abstract :
[en] [en] PURPOSE /OBJECTIVE: To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative.
MATERIAL AND METHODS: The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs.
RESULTS: 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time.
CONCLUSION: QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool.
Disciplines :
Oncology
Author, co-author :
Vaandering, Aude; UCL Cliniques Universitaires St Luc, Department of radiation oncology, Brussels, Belgium, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium. Electronic address: aude.vaadering@saintluc.uclouvain.be
Jansen, Nicolas ; Centre Hospitalier Universitaire de Liège - CHU > > Service médical de radiothérapie
Weltens, Caroline; Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
Moretti, Luigi; Institut Jules Bordet, Department of radiation oncology, Brussels, Belgium
Stellamans, Karin; AZ Groeninge, Department of radiation oncology, Kortrijk, Belgium
Vanhoutte, Frederik; Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
Scalliet, Pierre; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
Remouchamps, Vincent; CHU-UCL Namur - site Saint Elisabeth, Department of radiation oncology, Namur, Belgium
Lievens, Yolande; Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
Belgian College for Physicians in Radiation Oncology
Language :
English
Title :
Radiotherapy-specific quality indicators at national level: How to make it happen.
We thank Kiswendsida SAWADOGO kiswendsida.sawadogo@saintluc.uclouvain.be and Aline VAN MAANEN aline.vanmaanen@saintluc.uclouvain.be – from the Department of Statistical Support of the Instut Roi Albert II for their support in setting of the RedCap platform for the data collection process, and John Vercauteren, Philippe Spaas, Michel Van Dycke, Danielle Van den Weijngaert and Richard Burette for their feedback during the development phase of the project. Additionally, we would like to thank the Belgian Federal Government for Public Health for the financial support provided to the Belgian College of Physicians in Radiation Oncology.
Kay, J.F.L., Health care benchmarking. Med Bull 12 (2007), 22–27, 10.1007/978-0-387-75448-2_2.
Sampurno, F., Cally, J., Opie, J.L., Kannan, A., Millar, J.L., Finelli, A., et al. Establishing a global quality of care benchmark report. Health Informatics J, 27, 2021.
Ellis, J., Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care. J Adv Nurs, 32, 2000.
World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Busse R, Klazinga N, Panteli D, Quentin W. Improving healthcare quality in Europe: characteristics, effectiveness and implementation of different strategies. 2019.
Donaldson, H., Cao, J., French, J., Gillan, C., Milosevic, M., Lam, C., et al. Quality standards in radiation medicine. Pract Radiat Oncol 4 (2014), 208–214, 10.1016/j.prro.2013.09.004.
Albert, J.M., Das, P., Quality indicators in radiation oncology. Int J Radiat Oncol Biol Phys 85 (2013), 904–911, 10.1016/j.ijrobp.2012.08.038.
Hayman, J., Measuring the quality of care in radiation oncology. Semin Radiat Oncol 18 (2008), 201–206, 10.1016/j.semradonc.2008.01.008.
van Lent, W.A.M., de Beer, R.D., van Triest, B., van Harten, W.H., Selecting indicators for international benchmarking of radiotherapy centres. J Radiother Pract 12 (2013), 26–38, 10.1017/S1460396911000513.
López Torrecilla J, Marín i Borràs S, Ruiz-Alonso A, Jaen Olasolo J, Vázquez de la Torre ML, Bóveda Carro E, et al. Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology. Clinical and Translational Oncology 2019;21:519–33. https://doi.org/10.1007/s12094-018-1943-z.
Harden S v., Chiew KL, Millar J, Vinod SK. Quality indicators for radiation oncology. J Med Imaging Radiat Oncol 2022;66:249–57. https://doi.org/10.1111/1754-9485.13373.
Ong, W.L., Foroudi, F., Milne, R.L., Millar, J.L., Are we choosing wisely in radiation oncology practice-findings from an australian population-based study. Int J Radiat Oncol Biol Phys 104 (2019), 1012–1016, 10.1016/J.IJROBP.2019.03.048.
Dunn, A., Costello, S., Imlach, F., Jo, E., Gurney, J., Simpson, R., et al. Using national data to model the New Zealand radiation oncology workforce. J Med Imaging Radiat Oncol 66 (2022), 708–716, 10.1111/1754-9485.13448.
Kron, T., Fox, C., Ebert, M.A., Thwaites, D., Quality management in radiotherapy treatment delivery. J Med Imaging Radiat Oncol 66 (2022), 279–290, 10.1111/1754-9485.13348.
Vaandering, A., Jornet, N., Scalliet, P., Coffey, M., Lievens, Y., Doing the right thing: quality in radiotherapy, a European perspective. Radiother Oncol, 2018, 10.1016/j.radonc.2018.02.017.
Vaandering A, Lievens Y, PScalliet P. Feasibility and impact of national peer reviewed clinical audits in radiotherapy departments. Radiotherapy and Oncology 2020;144:218–23. https://doi.org/10.1016/j.radonc.2020.01.012.
Scalliet PGM, College F. Clinical radiotherapy audits in Belgium, 2011 − 2014 Audits cliniques en radiothérapie en Belgique, 2011 − 2014 2015;19:621–3.
Joye, I., Lambrecht, M., Jegou, D., Hortobágyi, E., Scalliet, P., Haustermans, K., Does a central review platform improve the quality of radiotherapy for rectal cancer? results of a national quality assurance project. Radiother Oncol 111 (2014), 400–405, 10.1016/J.RADONC.2014.03.003.
Verhoeven, K., Weltens, C., Remouchamps, V., Mahjoubi, K., Veldeman, L., Lengele, B., et al. Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy – PROCAB guidelines. Radiother Oncol 114 (2015), 11–16, 10.1016/J.RADONC.2014.11.008.
Charlier, F., Descamps, T., Lievens, Y., Geets, X., Remouchamps, V., Lambrecht, M., et al. ProCaLung – peer review in stage III, mediastinal node-positive, non-small-cell lung cancer: how to benchmark clinical practice of nodal target volume definition and delineation in Belgium☆. Radiother Oncol 167 (2022), 57–64, 10.1016/J.RADONC.2021.11.034.
van der Veen, J., Gulyban, A., Nuyts, S., Interobserver variability in delineation of target volumes in head and neck cancer. Radiother Oncol 137 (2019), 9–15, 10.1016/J.RADONC.2019.04.006.
Yalvac, B., Reulens, N.R., Schroeyers, W., Schreurs, S., Reniers, B., BELdART: a Belgian dosimetry audit programme in radiotherapy based on alanine/EPR and radiochromic film dosimetry. SSDL Newsletter, 2019, 70.
Schaeken, B., Cuypers, R., Lelie, S., Schroeyers, W., Schreurs, S., Janssens, H., et al. Implementation of alanine/EPR as transfer dosimetry system in a radiotherapy audit programme in Belgium. Radiother Oncol 99 (2011), 94–96, 10.1016/j.radonc.2011.01.026.
Donabedian A. Special article: The quality of care: How can it be assessed ? JAMA: The Journal of the American Medical Association 1988;260:1743–8.
Mainz, J., Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15 (2003), 523–530, 10.1093/intqhc/mzg081.
Bentzen, S.M., Heeren, G., Cottier, B., Slotman, B., Glimelius, B., Lievens, Y., et al. Towards evidence-based guidelines for radiotherapy infrastructure and staffing needs in Europe: the ESTRO QUARTS project. Radiother Oncol 75 (2005), 355–365, 10.1016/J.RADONC.2004.12.007.
Grau, C., Defourny, N., Malicki, J., Dunscombe, P., Borras, J.M., Coffey, M., et al. Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey. Radiother Oncol 112 (2014), 155–164, 10.1016/J.RADONC.2014.08.029.
Dunscombe, P., Grau, C., Defourny, N., Malicki, J., Borras, J.M., Coffey, M., et al. Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey. Radiother Oncol 112 (2014), 165–170, 10.1016/j.radonc.2014.08.032.
International Atomic Energy Agency (IAEA). Planning National Radiotherapy Services: a Practical Tool. IAEA Human Health Reports Eries No 14 2010:100.
Borras, J.M., Lievens, Y., Dunscombe, P., Coffey, M., Malicki, J., Corral, J., et al. The optimal utilization proportion of external beam radiotherapy in European countries: an ESTRO-HERO analysis. Radiother Oncol 116 (2015), 38–44, 10.1016/j.radonc.2015.04.018.
Slotman, B.J., Cottier, B., Bentzen, S.M.S.M., Heeren, G., Lievens, Y., van den Bogaert, W., Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: Work package 1. Radiother Oncol, 2005, 75, 10.1016/j.radonc.2004.12.005.
Lievens, Y., Defourny, N., Coffey, M., Borras, J.M., Dunscombe, P., Slotman, B., et al. Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey. Radiother Oncol 112 (2014), 178–186, 10.1016/j.radonc.2014.08.034.
Observatoire national de la radiothérapie - Situation fin 2013 et évolution depuis 2009 - Ref: ETOBSRTH15 n.d. https://www.e-cancer.fr/Expertises-et-publications/Catalogue-des-publications/Observatoire-national-de-la-radiotherapie-Situation-fin-2013-et-evolution-depuis-2009 (accessed March 22, 2022).
The Royal College of Radiologists. The timely delivery of radical radiotherapy: standards and guidelines for the management of unscheduled treatment interruptions, Third edition. 2008.
National Institute of Cancer. Common Terminology Criteria for Adverse Events (CTCAE). NIH Publication 2010;2009:0–71. https://doi.org/10.1080/00140139.2010.489653.
Harris, P.A., Taylor, R., Minor, B.L., Elliott, V., Fernandez, M., O'Neal, L., et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform, 95, 2019, 10.1016/j.jbi.2019.103208.
Harris, P.A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., Conde, J.G., Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42 (2009), 377–381, 10.1016/j.jbi.2008.08.010.
van de Voorde C, van den Heede K, Beguin C, Bouckaert N, Camberlin C, de Bekker Zorgvuldig Advies P, et al. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services – Supplement n.d.
Ayanian JZ, Markel H, Ph D. Donabedian ’ s Lasting Framework for Health Care Quality 2016:205–7. https://doi.org/10.1056/NEJMp1605101.
Vuk, T., Quality indicators: a tool for quality monitoring and improvement. ISBT Sci Ser 7 (2012), 24–28, 10.1111/J.1751-2824.2012.01584.X.
Cionini, L., Gardani, G., Gabriele, P., Magri, S., Morosini, P.L., Rosi, A., et al. Quality indicators in radiotherapy. Radiother Oncol 82 (2007), 191–200, 10.1016/j.radonc.2006.12.009.
Gabriele, P., Maggio, A., Garibaldi, E., Bracco, C., Delmastro, E., Gabriele, D., et al. Quality indicators in the intensity modulated/image-guided radiotherapy era. Crit Rev Oncol Hematol 108 (2016), 52–61, 10.1016/j.critrevonc.2016.10.013.
van Overveld, L.F.J., Braspenning, J.C.C., Hermens, R.P.M.G., Quality indicators of integrated care for patients with head and neck cancer. Clin Otolaryngol 42 (2017), 322–329, 10.1111/COA.12724.
Tsiamis, E., Millar, J., Baxi, S., Borg, M., de Ieso, P., Elsaleh, H., et al. Development of quality indicators to monitor radiotherapy care for men with prostate cancer: a modified Delphi method. Radiother Oncol 128 (2018), 308–314, 10.1016/j.radonc.2018.04.017.
Danielson, B., Brundage, M., Pearcey, R., Bass, B., Pickles, T., Bahary, J.P., et al. Development of indicators of the quality of radiotherapy for localized prostate cancer. Radiother Oncol 99 (2011), 29–36, 10.1016/j.radonc.2011.02.013.
Best, L., de Metz, C., Olivotto, I.A., Roy, I., Whelan, T., Arsenault, J., et al. Radiation therapy quality indicators for invasive breast cancer. Radiother Oncol 123 (2017), 288–293, 10.1016/J.RADONC.2017.03.022.
Fogarty, T., Tacey, M., McCorkell, G., Kok, D., Hornby, C., Milne, R.L., et al. Patterns of the use of advanced radiation therapy techniques for the management of bone metastases and the associated factors in Victoria. J Med Imaging Radiat Oncol 66 (2022), 678–687, 10.1111/1754-9485.13381.
Ong, W.L., Khor, R., Chao, M., Milne, R.L., Millar, J., Foroudi, F., Choosing Wisely in radiation therapy for breast cancer: time lag in adoption of hypofractionated radiation therapy in Victoria. J Med Imaging Radiat Oncol 65 (2021), 224–232, 10.1111/1754-9485.13155.
Selvik, J.T., Bansal, S., Abrahamsen, E.B., On the use of criteria based on the SMART acronym to assess quality of performance indicators for safety management in process industries. J Loss Prev Process Ind, 70, 2021, 104392, 10.1016/J.JLP.2021.104392.
Service Public Fédéral - Santé publique. Actions du plan cancer. https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/actions.pdf (accessed on 15/11/2022).
Wilson LL. The Quality Manager. J Qual Clin Pract. 2000 Dec;20(4):127-30. doi: 10.1046/j.1440-1762.2000.00375.x. PMID: 11207949.
Gagliardi, A.R., Majewski, C., Victor, J.C., Baker, G.R., Quality improvement capacity: a survey of hospital quality managers. Qual Saf Health Care 19 (2010), 27–30, 10.1136/qshc.2008.029967.
Mulliez, T., Veldeman, L., Speleers, B., Mahjoubi, K., Remouchamps, V., van Greveling, A., et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol 114 (2015), 79–84, 10.1016/J.RADONC.2014.11.038.
Nutting, C.M., Morden, J.P., Harrington, K.J., Urbano, T.G., Bhide, S.A., Clark, C., et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12 (2011), 127–136, 10.1016/S1470-2045(10)70290-4/ATTACHMENT/A437B3FA-E620-4B77-BC64-8FC74759E443/MMC1.PDF.
Dearnaley, D., Syndikus, I., Mossop, H., Khoo, V., Birtle, A., Bloomfield, D., et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol, 17, 2016, 1047, 10.1016/S1470-2045(16)30102-4.
Murray Brunt, A., Haviland, J.S., Wheatley, D.A., Sydenham, M.A., Alhasso, A., Bloomfield, D.J., et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 395 (2020), 1613–1626, 10.1016/S0140-6736(20)30932-6/ATTACHMENT/1B574B38-0B59-4BAF-A527-0E0168E913A9/MMC1.PDF.
Rodin, D., Tawk, B., Mohamad, O., Grover, S., Moraes, F.Y., Yap, M.L., et al. Hypofractionated radiotherapy in the real-world setting: an international ESTRO-GIRO survey. Radiother Oncol, 157, 2021, 32, 10.1016/J.RADONC.2021.01.003.
Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy n.d. https://doi.org/10.1016/j.radonc.2006.12.008.
Haviland, J.S., Owen, J.R., Dewar, J.A., Agrawal, R.K., Barrett, J., Barrett-Lee, P.J., et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14 (2013), 1086–1094, 10.1016/S1470-2045(13)70386-3/ATTACHMENT/249B2521-12BC-414A-AF19-C3CEB226DC2C/MMC1.PDF.
Bibault, J.-E., Giraud, P., Burgun, A., Big Data and machine learning in radiation oncology: state of the art and future prospects. Cancer Lett 382 (2016), 110–117, 10.1016/j.canlet.2016.05.033.
Zhang, L., Hub, M., Mang, S., Thieke, C., Nix, O., Karger, C.P., et al. Software for quantitative analysis of radiotherapy: overview, requirement analysis and design solutions. Comput Methods Programs Biomed 110 (2013), 528–537, 10.1016/j.cmpb.2013.03.002.
Nyholm, T., Olsson, C., Agrup, M., Björk, P., Björk-Eriksson, T., Gagliardi, G., et al. A national approach for automated collection of standardized and population-based radiation therapy data in Sweden. Radiother Oncol 119 (2016), 344–350, 10.1016/j.radonc.2016.04.007.
Potters, L., Ford, E., Evans, S., Pawlicki, T., Mutic, S., A systems approach using big data to improve safety and quality in radiation oncology. Int J Radiat Oncol Biol Phys 95 (2016), 885–889, 10.1016/j.ijrobp.2015.10.024.
Efstathiou J a, Nassif DS, McNutt TR, Bogardus CB, Bosch W, Carlin J, et al. Practice-based evidence to evidence-based practice: building the National Radiation Oncology Registry. Journal of Oncology Practice / American Society of Clinical Oncology 2013;9:e90-5. https://doi.org/10.1200/JOP.2013.001003.
Schang, L., Blotenberg, I., Boywitt, D., What makes a good quality indicator set? a systematic review of criteria. Int J Qual Health Care 33 (2021), 1–10, 10.1093/INTQHC/MZAB107.
Rubin HR, Pronovost P, Diette GB. Methodology Matters From a process of care to a measure: the development and testing of a quality indicator. vol. 13. 2001.
Brouwers, P.J.A.M., van Loon, J., Houben, R.M.A., Paulissen, J., Engelen, S.M.E., Heuts, M., et al. Are PROMs sufficient to record late outcome of breast cancer patients treated with radiotherapy ? a comparison between patient and clinician reported outcome through an outpatient clinic after 10 years of follow up. Radiother Oncol 126 (2018), 163–169, 10.1016/j.radonc.2017.08.004.
Mukesh, M.B., Qian, W., Wah Hak, C.C., Wilkinson, J.S., Barnett, G.C., Moody, A.M., et al. The Cambridge Breast Intensity-modulated Radiotherapy Trial: Comparison of Clinician- versus Patient-reported Outcomes. Clin Oncol 28 (2016), 354–364, 10.1016/j.clon.2016.02.011.
Bhattacharya, I.S., Haviland, J.S., Hopwood, P., Coles, C.E., Yarnold, J.R., Bliss, J.M., et al. Can patient-reported outcomes be used instead of clinician-reported outcomes and photographs as primary endpoints of late normal tissue effects in breast radiotherapy trials? results from the IMPORT LOW trial. Radiother Oncol 134 (2019), 220–230, 10.1016/j.radonc.2019.01.036.
Caissie, A., Brown, E., Olson, R., Barbera, L., Davis, C.-A., Brundage, M., et al. Improving patient outcomes and radiotherapy systems: a pan-Canadian approach to patient-reported outcome use. Med Phys 45 (2018), e841–e844, 10.1002/MP.12878.
Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom. n.d.
