'Disease-Management-Programm (DMP) Brustkrebs' und Versorgungsstruktur bei der operativen Therapie des Mammakarzinoms in Hessen 2002

Autor: Klaus König, A. du Bois, Uwe Wagner, K. Gnauert, G Hoffmann, C. Jackisch, B. Misselwitz, G. Schneidewind
Rok vydání: 2004
Předmět:
Zdroj: Geburtshilfe und Frauenheilkunde. 64:261-270
ISSN: 1438-8804
0016-5751
Popis: Purpose: Breast cancer is the most frequent malignancy in women and, therefore, the pattern of care is a major concern of health politics. German legislation started an initiative to improve the quality of care in chronic diseases. Breast cancer was one of four diseases selected for inclusion in this program, the so-called Disease-Management Program (DMP) in 2003. DMP demands an infrastructure based on interdisciplinary networks providing integrated care. Pilot projects were started in Hessen in two regions (Wiesbaden and Marburg). The infrastructure of both pilot projects is explained. One inclusion criteria for hospitals willing to participate in such models is a certain minimum experience with breast cancer surgery, defined as a minimally required number of 50 breast surgeries per year. Material and Methods: We analysed the numbers of breast surgeries per hospital in Hessen in 2001 and 2002. Furthermore, the relationship between the numbers of surgical procedures and selected quality parameters (e.g. rates of breast conserving therapy) was analysed. Data came from hospital accounts of all hospitals treating breast cancer in Hessen in 2001 and 2002. Results: Numerical criteria for participation in the DMP were already fulfilled in 30 of 85 hospitals in Hessen in 2000. Further centralisation was observed in the following years. The proportion of patients being operated on in hospitals with at least 50 breast surgeries per year increased from 75% in 2001 to 80% in 2002 (p < 0.0001). A comparison between hospitals with 50+ surgeries per year with less experienced hospitals revealed that the rate of breast conserving therapy was higher in high volume hospitals (66 vs. 53%; p < 0.0001). Conclusion: The distribution of frequency of breast cancer surgery per hospital and year in Hessen allows the introduction of DMP. Planned DMP associated scientific programs should evaluate the impact on quality of care by introducing DMP to clinical routine.
Databáze: OpenAIRE
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