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abstract
International Journal of Gynecological Cancer:
Objectives: The surgical management of advanced
ovarian cancer involves complex surgery. Implementation of a quality
management program has a major impact on survival. The goal of this work
was to develop a list of quality indicators (QIs) for advanced ovarian
cancer surgery that can be used to audit and improve the clinical
practice. This task has been carried out under the auspices of the
European Society of Gynaecologic Oncology (ESGO).
Methods: Quality indicators were based on scientific
evidence and/or expert consensus. A 4-step evaluation process included a
systematic literature search for the identification of potential QIs
and the documentation of scientific evidence, physical meetings of an ad
hoc multidisciplinarity International Development Group, an internal
validation of the targets and scoring system, and an external review
process involving physicians and patients.
Results: Ten structural, process, or outcome
indicators were selected. Quality indicators 1 to 3 are related to
achievement of complete cytoreduction, caseload in the center, training,
and experience of the surgeon. Quality indicators 4 to 6 are related to
the overall management, including active participation to clinical
research, decision-making process within a structured multidisciplinary
team, and preoperative workup. Quality indicator 7 addresses the high
value of adequate perioperative management. Quality indicators 8 to 10
highlight the need of recording pertinent information relevant to
improvement of quality. An ESGO-approved template for the operative
report has been designed. Quality indicators were described using a
structured format specifying what the indicator is measuring,
measurability specifications, and targets. Each QI was associated with a
score, and an assessment form was built.
Conclusions: The ESGO quality criteria can be used for
self-assessment, for institutional or governmental quality assurance
programs, and for the certification of centers. Quality indicators and
corresponding targets give practitioners and health administrators a
quantitative basis for improving care and organizational processes in
the surgical management of advanced ovarian cancer.
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