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The QUIRO Study (assurance of quality and innovation in radiooncology): methodology, instruments and practices

Die QUIRO-Studie (Qualitäts- und Innovationssicherung in der Radioonkologie): Methodik, Instrumente und Verfahren

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Abstract

Purpose

The QUIRO study aimed to establish a secure level of quality and innovation in radiation oncology. Over 6 years, 27 specific surveys were conducted at 24 radiooncological departments. In all, 36 renowned experts from the field of radiation oncology (mostly head physicians and full professors) supported the realization of the study.

Methods

A salient feature of the chosen methodological approach is the “process” as a means of systematizing diversified medical–technical procedures according to standardized criteria. On the one hand, “processes” as a tool of translation are adapted for creating and transforming standards into concrete clinical and medical actions; on the other hand, they provide the basis for standardized instruments and methods to determine the required needs of physicians, staff, and equipment. In the foreground of the collection and measurement of resource requirements were the processes of direct service provision which were subdivided into modules for reasons of clarity and comprehensibility. Overhead tasks (i.e., participation in quality management) were excluded from the main study and examined in a separate survey with appropriate methods.

Results

After the exploration of guidelines, tumor- or indication-specific examination and treatment processes were developed in expert workshops. Moreover, those specific modules were defined which characterize these entities and indications in a special degree. Afterwards, these modules were compiled according to their time and resources required in the “reference institution”, i.e., in specialized and as competent recognized departments (mostly from the university area), by various suitable survey methods.

Conclusion

The significance of the QUIRO study and the validity of the results were optimized in a process of constant improvements and comprehensive checks. As a consequence, the QUIRO study yields representative results concerning the resource requirement for specialized, qualitatively and technologically highly sophisticated radiooncologic treatment in Germany

Zusammenfassung

Ziel

Die QUIRO-Studie verfolgte das Ziel der Sicherung von Qualität und Innovation in der Radioonkologie. In einem Zeitraum von 6 Jahren wurden 27 Einzelerhebungen an 24 Kliniken durchgeführt. Dabei unterstützten 36 namhafte Fachexperten aus der Radioonkologie (mehrheitlich Chefärzte und Lehrstuhlinhaber) die Umsetzung der Studie.

Methoden

Hervorstechendes Merkmal des gewählten methodischen Ansatzes ist der „Prozess“ als Mittel der Systematisierung verschiedener medizinisch-technischer Abläufe nach einheitlichen Kriterien. „Prozesse“ sind als Umsetzungswerkzeuge einerseits geeignet, Normen zu schaffen und in konkretes klinisches wie ärztliches Handeln zu überführen, anderseits liefern sie die Basis, um mit standardisierten Instrumenten und Verfahren den Ressourcenbedarf an Ärzten, Personal und Technik zu ermitteln. Im Vordergrund der Erhebung und Messung des Ressourcenbedarfs standen die Prozesse der unmittelbaren Leistungserbringung, die zur Verbesserung der Übersichtlichkeit des komplexen Versorgungsgeschehens in Module untergliedert wurden. Aufgabenstellungen des Overheads (wie z. B. Beteiligung an Klinik- oder Qualitätsmanagement) wurden aus der Hauptstudie ausgeklammert und im Rahmen einer separaten Erhebung mit einem hierfür spezifisch geeigneten Design untersucht.

Ergebnisse

Nach Exploration und Analyse von Leitlinien wurden tumor- bzw. indikationsspezifische Untersuchungs- und Behandlungsprozesse in Expertenworkshops entwickelt sowie jene spezifischen Module definiert, die diese Entitäten und Indikationen in besonderem Maße charakterisieren. Anschließend wurden diese Module im Hinblick auf ihren erforderlichen Zeit- und Resourcenbedarf zusammengestellt, nachdem dieser in „Referenzeinrichtungen“, d. h. in darauf spezialisierten und als besonders kompetent ausgewiesenen Kliniken (mehrheitlich aus dem universitären Bereich) mit verschiedenen geeigneten Erhebungsmethoden ermittelt wurde.

Schlußfolgerung

Die Aussagekraft der QUIRO-Studie sowie die Validität der Ergebnisse wurden in einem Prozess steter Verfahrensverbesserungen und umfassender Plausibilitätsprüfungen optimiert. In der Summe gibt die QUIRO-Studie ein repräsentatives Bild des Ressourcenbedarfs bei spezialisierter qualitativer und technologisch hochstehender radioonkologischer Versorgung in Deutschland.

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Compliance with ethical guidelines

Conflict of interest. J. Dunst, N. Willich, H. Sack, R. Engenhart-Cabillic, V. Budach, and W. Popp state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. University of Lübeck, Lübeck, Germany

    J. Dunst

  2. University of Münster, Münster, Germany

    N. Willich

  3. German Society of Radiation Oncology (DEGRO), Berlin, Germany

    H. Sack

  4. University of Marburg, Marburg, Germany

    R. Engenhart-Cabillic

  5. Charité Berlin, Berlin, Germany

    V. Budach

  6. Burgunderstr. 14, 4051, Basel, Switzerland

    W. Popp

Authors
  1. J. Dunst
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  2. N. Willich
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  3. H. Sack
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  4. R. Engenhart-Cabillic
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  5. V. Budach
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  6. W. Popp
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Corresponding author

Correspondence to W. Popp.

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Dunst, J., Willich, N., Sack, H. et al. The QUIRO Study (assurance of quality and innovation in radiooncology): methodology, instruments and practices. Strahlenther Onkol 190, 138–148 (2014). https://doi.org/10.1007/s00066-013-0555-3

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  • DOI: https://doi.org/10.1007/s00066-013-0555-3

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