gms | German Medical Science

Objective: Certifications of specialized oncological centres play an increasing role in quality management and quality assurance. There are currently 42 neuro-oncological modules certified by the German Cancer Society (DKG). The objective of this study is to assess the impact of the certification process on the quality of care and to further identify challenges within the certification process based on a single centre’s experience.

Methods: Quantitative and qualitative data were collected from documents submitted for DKG certifications for each observed year (2014-2019). To identify trends in performance indices, statistical analysis was performed using a Mann-Kendall trend test, with a p-value of < 0.05 considered significant.

Results: The initial implementation of the certification process increased the number of preoperative case presentations in tumor conferences (TCs) and of patients included into clinical trials (case presentation TC quota from 37% in 2014 to 94% in 2015, clinical trial inclusion from 0% in 2014 to 33% in 2017). However, after primary certification, there were no further significant changes in any of the categories required by the DKG (e.g., primary neuro-oncological cases, TC presentation quotas, psycho-oncological counseling, and postoperative complications). Auditor recommendations during the certification process catalyzed structural and organizational quality improvements such as additional staffing dedicated to care of tumour patients, the implementation of a fully digitalized drug prescription system, and improved documentation of operative procedures. The preparation for yearly certification processes decreased from approximately 3 months to 3 weeks. Meeting the > 95% preoperative TC quota was considered as the main challenge in order to obtain certification.

Conclusion: Primary certification of a neuro-oncological centre can increase multidisciplinary-based decision making and scientific commitment. Further improvements in tumour patient care may arise from suggestions below the level of formal certification criteria. The amount of work per certification process decreases significantly with growing experience. The certification procedure provides opportunities to critically evaluate and optimize interdisciplinary neuro-oncological care – thereby serving as a catalyst rather than a generator of clinical quality and performance. Regular recertifications warrant a once achieved standard of care.