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Single institution followed by national implementation of systematic surgical quality control and feedback for radical prostatectomy: a 20-year journey

Journal article
Authors Johan Stranne
Elin Axén
Ingela Franck Lissbrant
P. Fransson
Maria Frånlund
Jonas Hugosson
Ali Khatami
Katarina Koss-Modig
Pär Lodding
Maria Nyberg
P. Stattin
Ola Bratt
Published in World Journal of Urology
ISSN 0724-4983
Publication year 2019
Published at Institute of Clinical Sciences, Department of Oncology
Institute of Clinical Sciences, Department of Urology
Language en
Links https://doi.org/10.1007/s00345-019-...
Keywords PROM, Prostate cancer, Quality control, Radical prostatectomy
Subject categories Urology and Nephrology, Cancer and Oncology

Abstract

Purpose: The demand for objective and outcome-based facts about surgical results after radical prostatectomy (RP) is increasing. Systematic feedback is also essential for each surgeon to improve his/her performance. Methods: RP outcome data (e.g., pT-stage and margin status) have been registered at Sahlgrenska University Hospital (SUH) since 1988 and patient-related outcome measures (PROM) have been registered since 2001. The National Prostate Cancer Registry (NPCR) has covered all Regions in Sweden since 1998 and includes PROM-data from 2008. Initially PROM was on-paper questionnaires but due since 2018 all PROMs are collected electronically. In 2014 an on-line “dashboard” panel was introduced, showing the results for ten quality-control variables in real-time. Since 2017 all RP data on hospital, regional, and national levels are publicly accessible on-line on “www.npcr.se/RATTEN”. Results: The early PROM-data from SUH have been used for internal quality control. As national clinical and PROM-data from the NPCR have been made accessible on-line and in real-time we have incorporated this into our pre-existing protocol. Our data are now internally available as real-time NPCR reports on the individual surgeons’ results, as well as ePROM data. We can compare the results of each surgeon internally and to other departments’ aggregated data. The public can access data and compare hospital level data on “RATTEN”. Conclusions: The process of quality control of RP locally at SUH, and nationally through the NPCR, has been long but fruitful. The online design, with direct real-time feedback to the institutions that report the data, is essential.

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