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Deepening Topics

Deepening Topics. Oncological Centers & OnkoZert-Certification Scheme. Example OnkoZert Certification: Topics. Basics about OnkoZert Oncological Centers Benefit of an oncological center Requirements regarding Tumour Boards Areas for Improvements regarding Tumor Boards. Topic.

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Deepening Topics

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  1. Deepening Topics Oncological Centers &OnkoZert-Certification Scheme

  2. Example OnkoZert Certification: Topics • Basics aboutOnkoZert • Oncological Centers • Benefitof an oncologicalcenter • RequirementsregardingTumour Boards • Areas forImprovementsregarding Tumor Boards

  3. Topic 1. Basics about OnkoZert

  4. OnkoZert What‘saboutOnkoZert? • Independent facility in Neu-Ulm/Germany • Developed the certificationsystemof the German Cancerassociation (DKG) fororgancancercenters and oncologicalcenters • Certification on the basisof the medicalrequirementsregarding the treatmentofoncologialpatients

  5. Structure of oncologial treatment centers 3-Stages-model oftheoncologicaltreatmentstructure CCC = ComprehensiveCancer Center CCC Oncological Center Organ Cancer Center

  6. Combi-model OnkoZert • Interdisciplinarycenter: • Separate legal personality • 4 protagonists • center (heads and coordinator) • Main treatmentpartners/keytreaters • Other cooperationpartners • Private practices and specialists • Point ofintersection: • Tumor board • Central target: • Consistent same qualityregardlesswhere the patientistransferredto the center

  7. Combi-model OnkoZert QM-System verification OnkoZert-Certification Seperatenetworkstructure and independent QM system: • Breast Center ISO-Certification KTQ-certification • Abdominal Cancer Center • ProstaticCancer Center • Skin Tumour Center • GynecologicalCancer Center Main treatmentpartners FacilitesClinical pathways • Lung Cancer Center ISO-Auditor forSystematic QM in FacilitiesaswellasforQM on centerlevel OnkoZert-Auditors formedico-scientificrequirements

  8. Combi-model OnkoZert

  9. Example: Key-Processofthe abdominal center

  10. OnkoZert-Requirements OnkoZert-Certificationsystem: • Forinterdisciplinarycancercenters • Oncological Center withmodules and oncologicalentities • Summary ofdata in elicitationsheet • Fulfilmentofrequirements in elicitationsheetnecessaryforcertification • Development and furtherdevelopmentbyinterdisciplinarycertificationcommitteesof the German Cancerassociation

  11. Key figures / Quality indicators Documentationof the oncologicaltreatment • Definition of uniform and understandable organ-specificrequirements, key-figures and qualityindicatorsby the German Cancerassociation, e.g. • Primary case • Operations • Complication • Preconditiontomeasure an increase in the treatmentsquality

  12. Key figures / Quality indicators Documentationof the oncologicalpatienttreatment • Key figuresbase on the actual S3 guidelinesorguidelinerecommendations • EvidencebasedMedicine:guideline implementations havetobeverifiedby the clinics in the dailytreatmentregimesduring the certificationprocess

  13. After treatment Registra-tion Admis-sion Diagnos-tic Therapy Release /Transfer Process organisation of an Center Key- and Part Processes: Oncologicalpatienttreatment

  14. After treatment Registra-tion Admis-sion Diagnos-tic Therapy Release /Transfer Intersections Intersectionsof the key-process: Oncologicalpatienttreatment

  15. Tumour Boards • Target: Evaluation and stagingof different tumourentities in a commoninterdisciplinaryweeklyconference on the basisoffirstdiagnosticresults • Tumor Boards are the corestructurefor the requestedinterdisciplinarycooperation and treatmentapproach • The discussion in TB followsestablishedfixedrules • Individual specialTumour Boards forspecialtumourentitiesarepossible

  16. 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)

  17. Tasks of the 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

  18. Requiremants regarding the TB implementation Procedurestoberegulatedfor the implementationof a Tumour Board • Cycle • Participants • Patient presentation • Preparation • Procedureof the performanceofaTumour Board • Tasks after finishing a Tumour Board:Information and executionof the recommendations

  19. Topic 2. Oncological Center

  20. Impact of an Oncological Center • Center for the evaluation and treatmentofnumerouestumourenties • Higher grade ofspecialisation: even the expertiseforvery rare diseasesisfocused in such a center • Preconditionfor the first OC-certification: Integration ofat least 2 organcancercenters and ofmodules (brain, head, mouth etc.) • Recertification (after 3 years):Integration ofat least 3 organcancercenters

  21. Structure of an OC OncologicalCancer Center Board/ SteeringCommittee, Center-coordination, Secretariate ModulesHead-Throat -CenterNeuro-oncologyPancreas Further Cancer- EntitiescentersGyn. Cancer Center Center forneuroendocrinaltumours Organ centersBreastcenterAbdominal cancercenter Lung cancercenter ExternalCooperation Partners Cooperation-partnersPsychooncologyStudy assistenceNursesPathologyRadiologyRadio-onocologyHematologyOncology etc. Clinics: General andVisceralSurgery, GynecologyandObstetrics, ENT, Oral andmaxillofacialsurgery, Internal Medicine: all Departments, Thoracicsurgery, endovascularsurgery, Neuro-surgery

  22. Rules of Order and development of the OC • 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

  23. Topic 3. Benefits from the Oncological Center

  24. Registra-tion Admission Diagnostic Aftertreatment Therapy Release/Transfer OC impact and benefit to clinics Oncological Center facilitates Useofsynergies Facilitationof Clinical Research Interdisciplinarity Improvedcommunication Technical and professional exchange Continuous, standardized, transparent processes High therapeuticstandards, preventionoffailures

  25. OC impact and benefit for clinics OC usessynergies in a region: General practicioners Self-helpgroups Specialistsand Consultants Tumourregister Physiotherapeutics Hospices Center forhistopathology Socialservices Clericalservices Ambulant nurses

  26. OC-impact and benefit for centers Board and Steeringcommitteeregulates and synchronices the cooperationwith the involvedorgancancercenters • Central coordinationof the cooperation • Central organisationoftumourboards • Increaseofpatientorientation • Benefitfor the Centers: • Systematic, positive influenceof the synergieswith the individual organ-centers and treatmentstructures

  27. OC-impact and benefit for patients Patientswithtumourdiseasesneedholistic, interdisciplinary and continuoustreatment. An Oncological Center ensuresfor: … also in rare and complexdiseases Treatment withhighestqualitystandard Frictionlessoutpatientandstationarytreatment Inclusionofthepatient Interdisciplinarydiagnosisandtherapy Continuityofholisticandcomprehensivetreatmentand ICF

  28. Patients treatment in OC

  29. Topic 4. Requirements for Tumor Boards according to OnkoZert

  30. Cycle and participants of Tumour Boards • Cycle: Performance at least 1 x weekly • Participants (competencelevel: seniorconsultants) • Relevant diagnostic, surgical and chemotherpeuticexpertise (organ-specific) • Radio-oncology • Hematology and Oncology • Pathology • Radiology

  31. Demand-actuated Participants Followingdisciplines/professionals havetobeadequatelyincludedinto the Tumour Boards: • Pharmacy Nurses • Surgery Psychooncology • Orthopetics specialpaintreatment • Neuro-surgery Study coordination • Neurology Palliative Medicine

  32. Special regulations • Participationofcooperationpartners in Tumour Boards: • If different cooperationpartnersfrom same disciplinework in the Tumor Board service, then the presenceofonerepresentativeof the disciplineisenough • Conditionforthat: a regularinformationprocedureisimplemented (e.g. via qualitycircles) • Independentlythereofeachcooperationpartnerhastoparticipateat least in 30 % of the Tumour Boards in a year

  33. Preparation • Writtensummaryof the patientsdata • Distribution of the summaryto the participants • Select from the patientspanelsuitablestudy-patients • Communication with the transferingpractitioners: • Admissionersareentitledtoparticipate in the Tumour Boards, whentheirpatientsareevaluated • Theyareentitledtopresent the clinicalstatus and theirclinicaldataoftheirpatients in the Tumour Board

  34. Presentation of Patient data • 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

  35. Performance Video conference • Underspecialconditionspossible(ifspecialOnkoZert-requirementsaremetforequipmentstatus and performance) • Video conferencesystem must bedemostrated online in the certificationaudit • The requirementsofOnkoZert must besatisfiedprecisely e.g. visibilityquality, evaluationpossibility, speechquality, operationofsystem, compensationconcept in malfunction

  36. Performance Demonstration Image material • Availabilityofpatientrelatedimages (pathology and radiology) • Suitabletechnicalequipmentfor the presentation and demonstrationof the images (computerizedpresentation)

  37. Advanced education • 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

  38. Impact of the results of the Tumour Boards • 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

  39. Documentation of the Tumour Board • 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

  40. Topic 5. Sometypicalareasforimprovementsof the performanceof a Tumour Board

  41. Patient management OC Areas for Improvement 1. Central registrationofpatientswith a minimumlead time

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

  43. Areas for Improvement 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

  44. Areas for Improvement 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

  45. Areas for Improvement 5. Room equipment and sitting order of the participants

  46. Areas for Improvement 6. Leadingof a Tumor Board bya Board member (Clinical Directors) ofthe Center orhisDeputy

  47. Areas for Improvement 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

  48. Areas for Improvement 10. Perfect images of highest quality of the pathologists and radiologists

  49. Areas for Improvement 11. Explanation of the pathological results by the pathologist and radiologist 12. Video conferences

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

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