Focus on Quality
Perspective
Reporting Program for Cancer Care Quality Indicators By Christoph Kowalski, PhD, Hilde Schulte, and Simone Wesselmann, MD German Cancer Society, Berlin; Hilde Schulte, Women’s Self-Help Following Cancer, Bonn, Germany Cancer care has made tremendous progress in recent decades, with the development of effective therapies, the implementation of clinical practice guidelines, health care provision through multidisciplinary and interprofessional teams at all stages of the disease, and patient-centered approaches to care provision, to mention only a few of the advances that have been made. However, putting these developments into practice in everyday care for the general population requires enormous effort on the part of health care providers and support from all of the stakeholders involved.1 To ensure that evidencebased, multidisciplinary, interprofessional, and patient-centered care is actually implemented in practice, it is not possible to rely solely on the goodwill of those who provide care. It is also necessary to ensure that—as a first step—the quality of care provided is transparent, so that successes and failures can be identified. As a second step, based on the results of the first, strategies for quality improvement need to be developed.2-5 We read with interest the recent exchange of ideas published in the pages of Journal of Oncology Practice and Journal of Clinical Oncology,6-8 as well as the reports by the Institute of Medicine (IOM) on the delivery of high-quality cancer care.9-11 We would like to outline here a program that has been in use since 2009 by an increasing number of certified cancer centers to report quality-of-care indicators. The reporting program is an integral part of a voluntary certification system that has been developed under the aegis of the German Cancer Society, following the publication of cancer survival rates in Europe, which showed that survival in Germany was unexpectedly low.12 The certification system for cancer centers was designed collaboratively by medical and professional associations involved in cancer care, as well as by patient support groups. The first breast cancer centers were established in 2003, and these were followed in 2006 by colorectal cancer centers and in 2008 by centers for lung, skin, prostate, and gynecologic cancers. Centers for pancreatic, neurologic, and head and neck cancer can also be certified as part of an oncological center that includes at least two of the other types mentioned. As of December 2, 2014, a total of 1,029 cancer center sites (998 in Germany, 19 in Switzerland, two in Italy, 10 in Austria), which treated approximately 150,000 patients with a first diagnosis of a malignant tumor during 2014, were certified. Many hospitals have more than one cancer center site certified (eg, a breast cancer and a colorectal cancer center). To give an impression of the increase in coverage: in 2012 the 882 certified sites are based in 430 of the 1,082 hospitals that treat patients with cancer in 158
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Germany (39.7%).13 Although the number of hospitals that serve patients with cancer in Germany is declining, the number of certified cancer center sites is increasing (2009: 325 hospitals with a certified cancer center site, 1,138 hospitals treating patients with cancer; 28.6%13). The certification system includes a reporting program with indicators for the quality of cancer care, a feature similar to the demand raised in component 5 of the IOM report: “translation of evidence into clinical practice, quality measurement, and performance improvement.”9(p5) The need for this type of reporting program has been repeatedly emphasized,11 and the program used in the German system is briefly described below. The reporting program forms part of a threefold cyclical process (Figure 1).
Certification Process and Reporting of Quality Indicators In order to be certified or recertified, cancer centers have to fulfill a distinct set of requirements, which for example include a minimum caseload, adherence to treatment recommendations in accordance with the evidence-based guidelines, and discussion of patients’ cases in multidisciplinary tumor conferences. In addition, every patient has to be provided with access to psycho-oncologists and social workers. These requirements reflect the aims of the certification system (multidisciplinarity, interprofessionality, guideline adherence, specialist expertise). The requirements are agreed on in a consensus process by the certification commission (equivalent to a “legislative” body), which consists of delegates from the relevant medical and professional associations. The certification process makes it possible for the aims defined in the certification system, and in particular the expertise encapsulated in the guidelines, to be put into practice. Many of the requirements are translated into quality indicators, many of which have target values and plausibility thresholds. Fulfillment of the quality indicators must be documented by the participating institutions using an electronic questionnaire, which is reported annually to OnkoZert, an independent quality assurance institute that organizes the data collection and auditing procedure on behalf of the German Cancer Society. Information on a total of 139,221 primary cancer patients was submitted in 2013. To ensure the validity of the data submitted, OnkoZert checks for completeness and consistency, and whenever a target value is not fulfilled or a plausibility threshold is not reached, the centers have to give reasons for these deviations. Each center’s documentation is then reviewed for correctness during an on-site auditing process conducted by
V O L . 11, I S S U E 2
Copyright © 2015 by American Society of Clinical Oncology
Reporting Program for Cancer Care Quality Indicators
Care provided in the cancer centers (certified network of clinical facilities)
QI reporting
Analysis of the results
Guideline commission*
Guideline revision
Certification commission†
Revision of requirements
Audit‡
Intervention planning
Figure 1. The reporting system, a threefold, cyclical process. QI, quality indicator. (*) Leitlinienprogramm Onkologie. (†) Deutsche Krebsgesellschaft. (‡) Deutsche Krebsgesellschaft and OnkoZert.
trained oncological medical experts, who examine a random 10% sample of patients’ medical files. These trained oncological medical experts (equivalent to an “executive” body) report the results of the audit to the board (the “judicial” body) that is responsible for issuing a certificate, which represents a seal of quality. Data reporting is mandatory for the centers, as certification (and recertification) is based on these data. If the data reported are incomplete or implausible, the centers are asked to complete the data, otherwise they are refused the certificate. The chances of having erroneous data reported are reduced by plausibility checks and on-site validation by the auditors. However, the data have been reported so far in an aggregated form for each center and each year; this serves the purposes of certification, but does not allow for individual-level analyses.
Using the Reporting System to Improve Care, Guidelines, and Certification Requirements The results for the quality indicators are evaluated annually for all certified centers and are reported back to them and to the public in the form of anonymous benchmark reports. These have been issued since the 2009 patient cohort (for breast cancers; other entities subsequently followed).14 As with other reporting programs for quality indicators,15 the centers use the reports to compare their own performance with those of the other certified centers and analyze their own development over time. The intention is not that the participating institutions should achieve as high as possible a degree of fulfillment of the requirements, but rather that processes of reflection should be initiated among those caring for patients so that they can develop strategies for constantly improving patient care. The auditing process in collaboration with oncological medical experts leads to intervention planning on a cooperative basis, and the effectiveness of the resulting intervention is then reviewed again during the next year’s audit. However, if reasonable and valid explanations for deviations are not provided, failure to fulfill requirements leads to the certificate being refused for the following year.
above is a system that “measures and assesses progress in improving the delivery of cancer care and publicly reports performance information; and develops innovative strategies for further improvement.”9(p5) The process involves substantial efforts to reduce the quality gap by sustainably implementing evidence-based information on a population-wide basis. The program is similar to other quality-enhancing approaches,19 in that it focuses on multidisciplinary care and quality indicators and in that patients with cancer can rely on being treated in accordance with high standards, not only in high-volume or teaching hospitals in metropolitan areas, but also in mediumsized hospitals in more rural locations. Certification of centers is part of the German National Cancer Plan, set out by the Ministry of Health.20 The certification program is still for the most part limited to Germany and the German-speaking regions of the other three countries, but in 2014 the first cancer center in the French-speaking part of Switzerland was certified. Further details on the certification program for breast, colorectal, and gynecologic cancers and the quality indicators used have been published elsewhere.21-25 As yet, the additional financial costs are not reimbursed throughout the German health care system, although this does take place at least partly in some German federal states. Despite the efforts, a total of 1,029 sites have so far taken up the challenge and have succeeded in receiving certification. Authors’ Disclosures of Potential Conflicts of Interest Disclosures provided by the authors are available with this article at jop.ascopubs.org.
Author Contributions Conception and design: All authors Manuscript writing: All authors Final approval of manuscript: All authors
Prospects
Corresponding author: Christoph Kowalski, PhD, Zertifizierung, Deutsche Krebsgesellschaft e.V., Kuno-Fischer-Strasse 8, 14057 Berlin, Germany; e-mail: [email protected].
Adherence to guidelines has repeatedly been reported to be low,16,17 and effective measures for reducing the quality gap by putting guidelines into practice are desperately needed.18 In line with the IOM report, the reporting program described
DOI: 10.1200/JOP.2014.001339; published online ahead of print at jop.ascopubs.org on February 3, 2015.
Copyright © 2015 by American Society of Clinical Oncology
M A R C H 2015
•
jop.ascopubs.org
159
Kowalski et al
References 1. Institute of Medicine and National Research Council: Ensuring Quality Cancer Care. Washington, DC, National Academies Press, 1999 2. National Research Council: Performance Measurement: Accelerating Improvement (Pathways to Quality Health Care Series). Washington, DC, National Academies Press, 2006 3. Donabedian A: The quality of care: How can it be assessed? JAMA 260:17431748, 1988 4. The Joint Commission: Performance Measures 2014. www.jointcommission. org/performance_measurement.aspx 5. Agency for Healthcare Research and Quality: National Quality Measures Clearinghouse 2014. www.qualitymeasures.ahrq.gov/ 6. Haines IE: Strategies to help oncologists deliver high-quality care. J Clin Oncol 32:1977-1978, 2014 7. Ganz PA, Levit LA: Reply to I.E. Haines. J Clin Oncol 32:1978, 2014
15. Bilimoria KY, Raval MV, Bentrem DJ, et al: National assessment of melanoma care using formally developed quality indicators. J Clin Oncol 27:5445-5451, 2009 16. Greenberg CC, Lipsitz SR, Neville B, et al: Receipt of appropriate surgical care for Medicare beneficiaries with cancer. Arch Surg 146:1128-1134, 2011 17. Patel JD, Krilov L, Adams S, et al: Clinical Cancer Advances 2013: Annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 32:129-160, 2014 18. Bilimoria KY: Moving beyond guidelines to ensure high-quality cancer care in the United States. J Oncol Pract 8:e67-e68, 2012 19. Halpern MT, Spain P, Holden DJ, et al: Improving quality of cancer care at community hospitals: Impact of the NCCCP pilot. J Oncol Pract 9:e298-e304, 2013
8. Ganz PA: Institute of Medicine report on delivery of high-quality cancer care. J Oncol Pract 10:193-195, 2014
20. German Ministry for Health: National Cancer Plan. www.bmg.bund.de/ praevention/nationaler-krebsplan/was-haben-wir-bisher-erreicht/ziel-5-qualita etssicherung-zertifizierung-onkologischer-behandlungseinrichtungen.html
9. Institute of Medicine, Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population: Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC, National Academies Press, 2013
21. Huthmann D, Seufferlein T, Post S, et al: Certified stomach cancer centres as seen by their directors: Results of a questionnaire to key personnel. Z Gastroenterol 50:753-739, 2012
10. Ganz PA, Levit LA: Charting a new course for the delivery of high-quality cancer care. J Clin Oncol 31:4485-4487, 2013
22. Kowalski C, Wesselmann S, Kreienberg R, et al: The patients’ view on accredited breast cancer centers: Strengths and potential for improvement. Geburtshilfe Frauenheilkd 72:137-143, 2012
11. Spinks T, Ganz PA, Sledge GW Jr, et al: Delivering high-quality cancer care: The critical role of quality measurement. Healthcare (Amst) 2:53-62, 2014 12. Sant M, Capocaccia R, Verdecchia A, et al: Survival of women with breast cancer in Europe: Variation with age, year of diagnosis and country. The EUROCARE Working Group. Int J Cancer 77:679-683, 1998 13. Research Data Centres of the Federal Statistical Office and the Statistical Offices of the Länder: Hospital statistic 2009, 2012. Data provided for individual calculation 14. German Cancer Society: 2014 Benchmarking Reports (in German). www. krebsgesellschaft.de/wub_zertifizierte_zentren_akutelles,200746.html; www.onkozert. de/hinweise_zertifizierung_benchmarking.htm
160
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23. Wesselmann S, Beckmann MW, Winter A: The concept of the certification system of the German Cancer Society and its impact on gynecological cancer care. Arch Gynecol Obstet 289:7-12, 2014 24. Wesselmann S, Winter A, Ferencz J, et al: Documented quality of care in certified colorectal cancer centers in Germany: German Cancer Society benchmarking report for 2013. Int J Colorectal Dis 29:511-518, 2014 25. Kowalski C, Ferencz J, Kreienberg R, et al: Quality of care in breast cancer centers 2009-2012: Results from the German Cancer Society benchmarking reports. Breast doi: 10.1016/j.breast.2014.11.014 [epub ahead of print on December 13, 2014]
V O L . 11, I S S U E 2
Copyright © 2015 by American Society of Clinical Oncology
Reporting Program for Cancer Care Quality Indicators
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Reporting Program for Cancer Care Quality Indicators The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I ⫽ Immediate Family Member, Inst ⫽ My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or jop.ascopubs.org/site/misc/ifc.xhtml. Christoph Kowalski No relationship to disclose
Simone Wesselmann No relationship to disclose
Hilde Schulte No relationship to disclose
Copyright © 2015 by American Society of Clinical Oncology
M A R C H 2015
•
jop.ascopubs.org
Copyright of Journal of Oncology Practice is the property of American Society of Clinical Oncology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Perspective
Reporting Program for Cancer Care Quality Indicators By Christoph Kowalski, PhD, Hilde Schulte, and Simone Wesselmann, MD German Cancer Society, Berlin; Hilde Schulte, Women’s Self-Help Following Cancer, Bonn, Germany Cancer care has made tremendous progress in recent decades, with the development of effective therapies, the implementation of clinical practice guidelines, health care provision through multidisciplinary and interprofessional teams at all stages of the disease, and patient-centered approaches to care provision, to mention only a few of the advances that have been made. However, putting these developments into practice in everyday care for the general population requires enormous effort on the part of health care providers and support from all of the stakeholders involved.1 To ensure that evidencebased, multidisciplinary, interprofessional, and patient-centered care is actually implemented in practice, it is not possible to rely solely on the goodwill of those who provide care. It is also necessary to ensure that—as a first step—the quality of care provided is transparent, so that successes and failures can be identified. As a second step, based on the results of the first, strategies for quality improvement need to be developed.2-5 We read with interest the recent exchange of ideas published in the pages of Journal of Oncology Practice and Journal of Clinical Oncology,6-8 as well as the reports by the Institute of Medicine (IOM) on the delivery of high-quality cancer care.9-11 We would like to outline here a program that has been in use since 2009 by an increasing number of certified cancer centers to report quality-of-care indicators. The reporting program is an integral part of a voluntary certification system that has been developed under the aegis of the German Cancer Society, following the publication of cancer survival rates in Europe, which showed that survival in Germany was unexpectedly low.12 The certification system for cancer centers was designed collaboratively by medical and professional associations involved in cancer care, as well as by patient support groups. The first breast cancer centers were established in 2003, and these were followed in 2006 by colorectal cancer centers and in 2008 by centers for lung, skin, prostate, and gynecologic cancers. Centers for pancreatic, neurologic, and head and neck cancer can also be certified as part of an oncological center that includes at least two of the other types mentioned. As of December 2, 2014, a total of 1,029 cancer center sites (998 in Germany, 19 in Switzerland, two in Italy, 10 in Austria), which treated approximately 150,000 patients with a first diagnosis of a malignant tumor during 2014, were certified. Many hospitals have more than one cancer center site certified (eg, a breast cancer and a colorectal cancer center). To give an impression of the increase in coverage: in 2012 the 882 certified sites are based in 430 of the 1,082 hospitals that treat patients with cancer in 158
JOURNAL
OF
ONCOLOGY PRACTICE
•
Germany (39.7%).13 Although the number of hospitals that serve patients with cancer in Germany is declining, the number of certified cancer center sites is increasing (2009: 325 hospitals with a certified cancer center site, 1,138 hospitals treating patients with cancer; 28.6%13). The certification system includes a reporting program with indicators for the quality of cancer care, a feature similar to the demand raised in component 5 of the IOM report: “translation of evidence into clinical practice, quality measurement, and performance improvement.”9(p5) The need for this type of reporting program has been repeatedly emphasized,11 and the program used in the German system is briefly described below. The reporting program forms part of a threefold cyclical process (Figure 1).
Certification Process and Reporting of Quality Indicators In order to be certified or recertified, cancer centers have to fulfill a distinct set of requirements, which for example include a minimum caseload, adherence to treatment recommendations in accordance with the evidence-based guidelines, and discussion of patients’ cases in multidisciplinary tumor conferences. In addition, every patient has to be provided with access to psycho-oncologists and social workers. These requirements reflect the aims of the certification system (multidisciplinarity, interprofessionality, guideline adherence, specialist expertise). The requirements are agreed on in a consensus process by the certification commission (equivalent to a “legislative” body), which consists of delegates from the relevant medical and professional associations. The certification process makes it possible for the aims defined in the certification system, and in particular the expertise encapsulated in the guidelines, to be put into practice. Many of the requirements are translated into quality indicators, many of which have target values and plausibility thresholds. Fulfillment of the quality indicators must be documented by the participating institutions using an electronic questionnaire, which is reported annually to OnkoZert, an independent quality assurance institute that organizes the data collection and auditing procedure on behalf of the German Cancer Society. Information on a total of 139,221 primary cancer patients was submitted in 2013. To ensure the validity of the data submitted, OnkoZert checks for completeness and consistency, and whenever a target value is not fulfilled or a plausibility threshold is not reached, the centers have to give reasons for these deviations. Each center’s documentation is then reviewed for correctness during an on-site auditing process conducted by
V O L . 11, I S S U E 2
Copyright © 2015 by American Society of Clinical Oncology
Reporting Program for Cancer Care Quality Indicators
Care provided in the cancer centers (certified network of clinical facilities)
QI reporting
Analysis of the results
Guideline commission*
Guideline revision
Certification commission†
Revision of requirements
Audit‡
Intervention planning
Figure 1. The reporting system, a threefold, cyclical process. QI, quality indicator. (*) Leitlinienprogramm Onkologie. (†) Deutsche Krebsgesellschaft. (‡) Deutsche Krebsgesellschaft and OnkoZert.
trained oncological medical experts, who examine a random 10% sample of patients’ medical files. These trained oncological medical experts (equivalent to an “executive” body) report the results of the audit to the board (the “judicial” body) that is responsible for issuing a certificate, which represents a seal of quality. Data reporting is mandatory for the centers, as certification (and recertification) is based on these data. If the data reported are incomplete or implausible, the centers are asked to complete the data, otherwise they are refused the certificate. The chances of having erroneous data reported are reduced by plausibility checks and on-site validation by the auditors. However, the data have been reported so far in an aggregated form for each center and each year; this serves the purposes of certification, but does not allow for individual-level analyses.
Using the Reporting System to Improve Care, Guidelines, and Certification Requirements The results for the quality indicators are evaluated annually for all certified centers and are reported back to them and to the public in the form of anonymous benchmark reports. These have been issued since the 2009 patient cohort (for breast cancers; other entities subsequently followed).14 As with other reporting programs for quality indicators,15 the centers use the reports to compare their own performance with those of the other certified centers and analyze their own development over time. The intention is not that the participating institutions should achieve as high as possible a degree of fulfillment of the requirements, but rather that processes of reflection should be initiated among those caring for patients so that they can develop strategies for constantly improving patient care. The auditing process in collaboration with oncological medical experts leads to intervention planning on a cooperative basis, and the effectiveness of the resulting intervention is then reviewed again during the next year’s audit. However, if reasonable and valid explanations for deviations are not provided, failure to fulfill requirements leads to the certificate being refused for the following year.
above is a system that “measures and assesses progress in improving the delivery of cancer care and publicly reports performance information; and develops innovative strategies for further improvement.”9(p5) The process involves substantial efforts to reduce the quality gap by sustainably implementing evidence-based information on a population-wide basis. The program is similar to other quality-enhancing approaches,19 in that it focuses on multidisciplinary care and quality indicators and in that patients with cancer can rely on being treated in accordance with high standards, not only in high-volume or teaching hospitals in metropolitan areas, but also in mediumsized hospitals in more rural locations. Certification of centers is part of the German National Cancer Plan, set out by the Ministry of Health.20 The certification program is still for the most part limited to Germany and the German-speaking regions of the other three countries, but in 2014 the first cancer center in the French-speaking part of Switzerland was certified. Further details on the certification program for breast, colorectal, and gynecologic cancers and the quality indicators used have been published elsewhere.21-25 As yet, the additional financial costs are not reimbursed throughout the German health care system, although this does take place at least partly in some German federal states. Despite the efforts, a total of 1,029 sites have so far taken up the challenge and have succeeded in receiving certification. Authors’ Disclosures of Potential Conflicts of Interest Disclosures provided by the authors are available with this article at jop.ascopubs.org.
Author Contributions Conception and design: All authors Manuscript writing: All authors Final approval of manuscript: All authors
Prospects
Corresponding author: Christoph Kowalski, PhD, Zertifizierung, Deutsche Krebsgesellschaft e.V., Kuno-Fischer-Strasse 8, 14057 Berlin, Germany; e-mail: [email protected].
Adherence to guidelines has repeatedly been reported to be low,16,17 and effective measures for reducing the quality gap by putting guidelines into practice are desperately needed.18 In line with the IOM report, the reporting program described
DOI: 10.1200/JOP.2014.001339; published online ahead of print at jop.ascopubs.org on February 3, 2015.
Copyright © 2015 by American Society of Clinical Oncology
M A R C H 2015
•
jop.ascopubs.org
159
Kowalski et al
References 1. Institute of Medicine and National Research Council: Ensuring Quality Cancer Care. Washington, DC, National Academies Press, 1999 2. National Research Council: Performance Measurement: Accelerating Improvement (Pathways to Quality Health Care Series). Washington, DC, National Academies Press, 2006 3. Donabedian A: The quality of care: How can it be assessed? JAMA 260:17431748, 1988 4. The Joint Commission: Performance Measures 2014. www.jointcommission. org/performance_measurement.aspx 5. Agency for Healthcare Research and Quality: National Quality Measures Clearinghouse 2014. www.qualitymeasures.ahrq.gov/ 6. Haines IE: Strategies to help oncologists deliver high-quality care. J Clin Oncol 32:1977-1978, 2014 7. Ganz PA, Levit LA: Reply to I.E. Haines. J Clin Oncol 32:1978, 2014
15. Bilimoria KY, Raval MV, Bentrem DJ, et al: National assessment of melanoma care using formally developed quality indicators. J Clin Oncol 27:5445-5451, 2009 16. Greenberg CC, Lipsitz SR, Neville B, et al: Receipt of appropriate surgical care for Medicare beneficiaries with cancer. Arch Surg 146:1128-1134, 2011 17. Patel JD, Krilov L, Adams S, et al: Clinical Cancer Advances 2013: Annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 32:129-160, 2014 18. Bilimoria KY: Moving beyond guidelines to ensure high-quality cancer care in the United States. J Oncol Pract 8:e67-e68, 2012 19. Halpern MT, Spain P, Holden DJ, et al: Improving quality of cancer care at community hospitals: Impact of the NCCCP pilot. J Oncol Pract 9:e298-e304, 2013
8. Ganz PA: Institute of Medicine report on delivery of high-quality cancer care. J Oncol Pract 10:193-195, 2014
20. German Ministry for Health: National Cancer Plan. www.bmg.bund.de/ praevention/nationaler-krebsplan/was-haben-wir-bisher-erreicht/ziel-5-qualita etssicherung-zertifizierung-onkologischer-behandlungseinrichtungen.html
9. Institute of Medicine, Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population: Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC, National Academies Press, 2013
21. Huthmann D, Seufferlein T, Post S, et al: Certified stomach cancer centres as seen by their directors: Results of a questionnaire to key personnel. Z Gastroenterol 50:753-739, 2012
10. Ganz PA, Levit LA: Charting a new course for the delivery of high-quality cancer care. J Clin Oncol 31:4485-4487, 2013
22. Kowalski C, Wesselmann S, Kreienberg R, et al: The patients’ view on accredited breast cancer centers: Strengths and potential for improvement. Geburtshilfe Frauenheilkd 72:137-143, 2012
11. Spinks T, Ganz PA, Sledge GW Jr, et al: Delivering high-quality cancer care: The critical role of quality measurement. Healthcare (Amst) 2:53-62, 2014 12. Sant M, Capocaccia R, Verdecchia A, et al: Survival of women with breast cancer in Europe: Variation with age, year of diagnosis and country. The EUROCARE Working Group. Int J Cancer 77:679-683, 1998 13. Research Data Centres of the Federal Statistical Office and the Statistical Offices of the Länder: Hospital statistic 2009, 2012. Data provided for individual calculation 14. German Cancer Society: 2014 Benchmarking Reports (in German). www. krebsgesellschaft.de/wub_zertifizierte_zentren_akutelles,200746.html; www.onkozert. de/hinweise_zertifizierung_benchmarking.htm
160
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23. Wesselmann S, Beckmann MW, Winter A: The concept of the certification system of the German Cancer Society and its impact on gynecological cancer care. Arch Gynecol Obstet 289:7-12, 2014 24. Wesselmann S, Winter A, Ferencz J, et al: Documented quality of care in certified colorectal cancer centers in Germany: German Cancer Society benchmarking report for 2013. Int J Colorectal Dis 29:511-518, 2014 25. Kowalski C, Ferencz J, Kreienberg R, et al: Quality of care in breast cancer centers 2009-2012: Results from the German Cancer Society benchmarking reports. Breast doi: 10.1016/j.breast.2014.11.014 [epub ahead of print on December 13, 2014]
V O L . 11, I S S U E 2
Copyright © 2015 by American Society of Clinical Oncology
Reporting Program for Cancer Care Quality Indicators
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Reporting Program for Cancer Care Quality Indicators The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I ⫽ Immediate Family Member, Inst ⫽ My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or jop.ascopubs.org/site/misc/ifc.xhtml. Christoph Kowalski No relationship to disclose
Simone Wesselmann No relationship to disclose
Hilde Schulte No relationship to disclose
Copyright © 2015 by American Society of Clinical Oncology
M A R C H 2015
•
jop.ascopubs.org
Copyright of Journal of Oncology Practice is the property of American Society of Clinical Oncology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
