Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

Area of Science:

• Oncology
• Healthcare Quality Improvement
• Clinical Practice Guidelines

Background:

• Evidence-based (S3) clinical practice guidelines for kidney and bladder cancer were developed by the German Guideline Program in Oncology.
• Quality indicators (QIs) were defined to assess the quality of care within these guidelines.
• The German Cancer Society (DKG) established two certification systems based on these guidelines and QIs.

Purpose of the Study:

• To outline the development and implementation process of QIs in cancer centers certified by the German Cancer Society (DKG).
• To demonstrate how guideline-derived QIs can be used to measure and improve the quality of cancer care.

Main Methods:

• QIs were derived from strong guideline recommendations and a systematic literature review of national and international indicators.
• A multistep standardized approach was used to create two sets of QIs: 9 for kidney cancer and 12 for bladder cancer.
• These QIs were integrated into certification data sheets for outcome measurement in certified centers.

Main Results:

• The final sets comprise 9 QIs for kidney cancer and 12 for bladder cancer.
• Approximately two-thirds of the derived QIs were successfully transferred to the certification data sheets.
• Results for 2018 and 2019 showed most QIs were within plausibility limits, with stricter targets introduced from 2020 onwards to drive improvement.

Conclusions:

• Guideline-derived QIs effectively make key aspects of patient care measurable and improvable.
• Initial QI results for kidney and bladder cancer are promising, indicating positive impacts on care quality.
• The DKG certification system and quality measurement methods are evolving, with systematic QI implementation and evaluation crucial for expanding knowledge and improving outcomes.