Deepening Topics

Dr. Erwig PinterQKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1

Oncological Centers &OnkoZert-Certification Scheme

Deepening Topics


1. Basics about OnkoZert 2. Oncological Centers3. Benefit of an oncological center4. Requirements regarding Tumour Boards5. Areas for Improvements regarding Tumor Boards

Example OnkoZert Certification: Topics


1. Basics about OnkoZert

Topic


What‘s about OnkoZert? Independent facility in Neu-Ulm/Germany Developed the certification system of the German

Cancer association (DKG) for organ cancer centers and oncological centers

Certification on the basis of the medical requirements regarding the treatment of oncologial patients

OnkoZert


Structure of oncologial treatment centers

3-Stages-model of the oncological treatment structure

Organ Cancer Center

Oncological Center

CCC = Comprehensive Cancer Center

CCC


Interdisciplinary center: Separate legal personality

4 protagonists center (heads and coordinator) Main treatment partners/key treaters Other cooperation partners Private practices and specialists

Point of intersection: Tumor board

Central target: Consistent same quality regardless where the patient is

transferred to the center

Combi-model OnkoZert



KTQ-certification

OnkoZert-Certification

QM-System verification

ISO-Certification

• Breast Center• Abdominal Cancer Center

• Lung Cancer CenterFacilitesClinical

pathways

Main treatment partners

Seperate network structure and independent QM system:

ISO-Auditor for Systematic QM in Facilities as well as for QM on center level

OnkoZert-Auditors for medico-scientific requirements

• Prostatic Cancer Center• Skin Tumour Center• Gynecological Cancer Center


Breast Cancer Center Abdominal Cancer Center

Prostatic Cancer Center

Main cooperation partner

Main cooperation partner

Treatment Care providers

Operating Surgeon Gyn. Oncologist Radiologist Pathologist Internal Oncologist Radio-oncologist Nuklear Medicine

Visceral Surgeon Gastroenterologist Radio-oncologist Internal Oncologist Pathologist Radiologist

Treatment Care providers I Urologist (diagnostic

+operative) Radio-oncologist

Treatment Care providers II Urologist or Internal Oncologist

(chemotherapy) Urologist (diagnostic) Radiologist Pathologist Nuklear Medicine



Informationand

organisation in center

Tumour Board:Recommendation

on therapy

ReleaseDiagnosis at specialist level

Posttherapeutic reevaluation of the patients treatment success:Informations on treatment progress,therapeutic changes, abortion

of treatment

General practicioner diagnoses:

Cancer?

Ssurgical treatment

Chemotherapeutics

radiooncologiy

Palliative care

Supportive care

Example: Key-Process of the abdominal center


OnkoZert-Certification system: For interdisciplinary cancer centers Oncological Center with modules and oncological

entities Summary of data in elicitation sheet Fulfilment of requirements in elicitation sheet

necessaryfor certification

Development and further development by interdisciplinary certification committees of the German Cancer association

OnkoZert-Requirements


Documentation of the oncological treatment Definition of uniform and understandable organ-

specific requirements, key-figures and quality indicators by the German Cancer association, e.g. Primary case Operations Complication

Precondition to measure an increase in the treatments quality

Key figures / Quality indicators


Documentation of the oncological patient treatment Key figures base on the actual S3 guidelines or

guideline recommendations

Evidence based Medicine:guideline implementations have to be verified by the clinics in the daily treatment regimes during the certification process

Key figures / Quality indicators


Key- and Part Processes: Oncological patient treatment

Process organisation of an Center

Registra-

tionAdmis-sion

Diagnos-tic

Therapy

Release /Transfe

r

After treatme

nt


Intersections

Intersections of the key-process: Oncological patient treatment

Registra-

tionAdmis-sion

Diagnos-tic

Therapy

Release /Transfe

r

After treatme

nt


Target: Evaluation and staging of different tumour entities in a common interdisciplinary weekly conference on the basis of first diagnostic results

Tumor Boards are the core structure for the requested interdisciplinary cooperation and treatment approach

The discussion in TB follows established fixed rules Individual special Tumour Boards for special tumour

entities are possible

Tumour Boards


Recommendations of the interdisciplinary team must be based on the evidence based medicine and the guidelines or regulations of the medical-scientific associations

Recommendations shold take reference to the guidelines. They shall not reformulate these new Workings out however of the local clinical

diagnostic and treatment procedures (SOPs) along the guidelines are required (Transfer of guidelines into the daily actual clinical treatment)

Tumour Boards


Recommendations in regard to further diagnostic, therapy and After-treatment procedures of individual patients

Planning of the further treatment of certain tumour patients or patients with recidives in the interdisciplinary team

Establishment and publication of the internal SOPs guidelines (SOPs) for the most important tumour diseases

Tasks of the Tumour Boards


Procedures to be regulated for the implementation of a Tumour Board Cycle Participants Patient presentation Preparation Procedure of the performance of aTumour Board Tasks after finishing a Tumour Board:

Information and execution of the recommendations

Requiremants regarding the TB implementation


2. Oncological Center

Topic


Center for the evaluation and treatment of numeroues tumour enties

Higher grade of specialisation: even the expertise for very rare diseases is focused in such a center

Precondition for the first OC-certification: Integration of at least 2 organ cancer centers and of modules (brain, head, mouth etc.)

Recertification (after 3 years):Integration of at least 3 organ cancer centers

Impact of an Oncological Center


Structure of an OC

Organ centersBreast centerAbdominal cancer centerLung cancer center

Further Cancer- Entities centersGyn. Cancer CenterCenter for neuroendocrinal tumours

ModulesHead-Throat -CenterNeuro-oncologyPancreas

Clinics: General and Visceral Surgery, Gynecology and Obstetrics, ENT, Oral and maxillofacial surgery, Internal Medicine: all Departments, Thoracic surgery, endovascular surgery, Neuro-surgery

Cooperation-partnersPsychooncologyStudy assistenceNursesPathologyRadiologyRadio-onocologyHematologyOncology etc.

Board/ Steering Committee, Center-coordination, Secretariate

Oncological Cancer Center

External Cooperation Partners


Clear targetting Set-up, organisational structure, personal of the OC Steering Committee Cooperation partners internal and external Operational and decision making procedures Core competencies and Tumour Boards Documentation of follow up of patients Quality Assurance Cost- and finance structure Action plans Public relations

Rules of Order and development of the OC


3. Benefits from the Oncological Center

Topic


Improved communication

Interdisciplinarity

Use of synergies

Continuous, standardized, transparent processesHigh therapeutic standards, prevention of failures

Technical and professional exchange

Oncological Center facilitates

OC impact and benefit to clinics

Facilitation of Clinical Research

Registra-tion

Admission

Diagnostic Therapy Release/

TransferAfter

treatment


OC uses synergies in a region:

OC impact and benefit for clinics

General practicioners

Center for histopathology

Tumour register

Self-help groups

Hospices

Physiotherapeutics

Ambulant nurses

Social servicesClerical services

Specialists and Consultants


Board and Steering committee regulates and synchronices the cooperation with the involved organ cancer centers Central coordination of the cooperation Central organisation of tumour boards

Increase of patient orientation Benefit for the Centers: Systematic, positive influence of the synergies with

the individual organ-centers and treatment structures

OC-impact and benefit for centers


Treatment with highest quality standard

Patients with tumour diseases need holistic, interdisciplinary and continuous treatment.An Oncological Center ensures for:

… also in rare and complex diseases

Inclusion of the patient

Continuity of holistic and comprehensive treatment and ICF

OC-impact and benefit for patients

Frictionless outpatient and stationary treatment

Interdisciplinary diagnosis and therapy


Patients treatment in OC

Tumour Boardrecommendations Monitoring

After treatment

Stem cell-/ bone marrow stem cell donator

and receiver

hematologic patients

onkologicpatients

oncologic patients

Cooperation partner of OC

Clinic Hematology and Onkologie

Patientmanagement

OC

Patient

Patient

Surgical Treatment

RadiooncologyRelease into patients home, reha o.ä.

Oncologic Center

Other therapies

Conservative treatment

Chemotherapeutics


4. Requirements for Tumor Boards according to OnkoZert

Topic


Cycle: Performance at least 1 x weekly Participants (competence level: senior consultants)

Relevant diagnostic, surgical and chemotherpeutic expertise (organ-specific)

Radio-oncology Hematology and Oncology Pathology Radiology

Cycle and participants of Tumour Boards


Following disciplines/professionals have to be adequately included into the Tumour Boards:

Pharmacy Nurses Surgery Psychooncology Orthopetics special pain treatment Neuro-surgery Study

coordination Neurology Palliative Medicine

Demand-actuated Participants


Participation of cooperation partners in Tumour Boards:

If different cooperation partners from same discipline work in the Tumor Board service, then the presence of one representative of the discipline is enough

Condition for that: a regular information procedure is implemented (e.g. via quality circles)

Independently thereof each cooperation partner has to participate at least in 30 % of the Tumour Boards in a year

Special regulations


Written summary of the patients data Distribution of the summary to the participants Select from the patients panel suitable study-

patients Communication with the transfering practitioners:

Admissioners are entitled to participate in the Tumour Boards, when their patients are evaluated

They are entitled to present the clinical status and their clinical data of their patients in the Tumour Board

Preparation


All tumour patients data are to be presented in a formal procedure and sequence

Organ-specific requirements Centers Moduls Main focuses

Exemptions must be reasoned All patients with recidives and metastases

Presentation of Patient data


Video conference Under special conditions possible

(if special OnkoZert-requirements are metfor equipment status and performance)

Video conference system must be demostrated online in the certification audit

The requirements of OnkoZert must be satisfied precisely e.g. visibility quality, evaluation possibility, speech quality, operation of system, compensation concept in malfunction

Performance


Demonstration Image material Availability of patient related images (pathology

and radiology) Suitable technical equipment for the presentation

and demonstration of the images (computerized presentation)

Performance


Mandatorily required is at least once a participation in the Tumour Boards of the following functions/ professionals: Assistence personal (MTA, TRA,…) from the

functions radiology, nuclear-medicine, radio-oncology

Social Service, Psychooncology, Pharmacy Specially oncology-trained nurses at least 2 for

a treatment unit Refreshment at least all three years

Advanced education


Plannings of treatment/recommendations of the Tumour Boards are binding

Deviations from the original therapy planning and guidelines must be reasoned, documented and evaluated

Adequate measures have to be taken, that deviations occur only in reasonable cinical situations

Informed consent of the patient about the recommendations of the Tumour Board

Therapy changes or abortion of the herapy according to the will of the patient have to be documented

Impact of the results of the Tumour Boards


The results of the Tumour Board is a written interdisciplinary treatment planning

Becomes part of patients documentation Can be the content of the release letter to the

transfering practitioner Documentation should be generated automatically

from the electronic tumour information system Patient gets a copy of the documentation on

demand

Documentation of the Tumour Board


5. Some typical areas for improvements

of the performance of a Tumour Board

Topic


1. Central registration of patients with a minimum lead time

Areas for Improvement

Patient management OC


2. Check of the patients documentation in OC regarding completeness. Demanding missing informations and results



3. Distribution of a list with the patients together with the informations and results to the participants in adequate time before the Tumour Board for their preparation



4. Self-preparation of the participants of the Tumour Board on the basis of the documention and possibly their own clinical knowledge of the patient



5. Room equipment and sitting order of the participants



6. Leading of a Tumor Board by a Board member (Clinical Directors) of the Center or his Deputy



7. Presentation of the patient after request of the head of the TB by a participant with the discipline nearest to the indication 8. Calling upon the patients along the prepared list

9. Concurrent documentation with concurrent control via beamer checking by the participants



10. Perfect images of highest quality of the pathologists and radiologists



11. Explanation of the pathological results by the pathologist and radiologist

12. Video conferences



13. Inclusion of the clinical knowledge about the patient by a presentation of the practicioner specialist if present



14. Summary documentation of all recommendations of the Tumour Board as well as a separate documentation on the treatment of a single patient. The summary document has to be signed by each participant. The individual patients document is to be signed by the Head of the Tumour Board.



15. The decision of the Tumour Board regarding the recommendation for a treatment of a patient must be clear, unmistakably and complete and shall constitute the strategic treatment planning.



16. The individual patient document with the Tumor Board decision shall become part of the patient file. The decision shall also be cited in the transfering letter to the practitioner as the essential treatment target.



17. Informed Consent of the patient about the recommendations of the Tumour Board for obtaining his consent to this treatment


Documents

Deepening Topics