Using the Delphi technique to improve clinical outcomes through the development of quality indicators in renal cell carcinoma.
OBJECTIVE
Optimal quality of care is needed for ideal outcomes. In renal cell carcinoma (RCC), there is a lack of information defining optimal care. This is particularly important in RCC, with increased complexity of care and a need for coordination among providers. The goal of this study was to identify quality indicators (QIs) and measures of quality care across the RCC disease spectrum.


METHODS
A modified Delphi technique was used to select QIs that are relevant and practical to RCC care. This technique involved an expert panel of 13 urologic and medical oncologists who participated in two e-mail questionnaires and an in-person meeting to review and prioritize potential QIs. These potential QIs were identified from a systematic literature review or were suggested by panel members.


RESULTS
From 233 literature citations, 34 possible QIs were identified; 24 additional potential QIs were suggested. A final set of 23 QIs was established. These are distributed across the RCC disease spectrum as follows (number of QIs in parentheses): screening (n=1), diagnosis/prognosis (n=3), surgical for localized disease (n=6), surgery for advanced disease (n=3), systemic therapy (n=6), and follow-up (n=2). In addition, two QIs related to survival outcomes (overall and progression-free survival) were selected.


CONCLUSIONS
A systematic, consensus-based approach was used to determine relevant QIs in RCC care. These 23 QIs will provide a means of evaluating the quality of RCC care in an effort to improve outcomes in patients. The next step will be to establish a means of measuring each QI based on defined or yet-to-be-defined benchmarks.
Queen Elizabeth II Health Sciences Centre; Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia; Sunnybrook Health Sciences Centre; St Michael's Hospital; Princess Margaret Hospital, University of Toronto, Toronto; University of Ottawa, Ottawa; St Joseph's Hospital, McMaster University, Hamilton, Ontario; Vancouver Prostate Centre, University of British Columbia; Vancouver Cancer Centre, University of British Columbia, Vancouver, British Columbia; Tom Baker Cancer Centre, Calgary; University of Alberta; Cross Cancer Institute, University of Alberta, Edmonton, Alberta; Centre Hospitalier de L'Université de Montreal, University of Montreal; and Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
Lori
L
Wood
Georg A
GA
Bjarnason
Peter C
PC
Black
Ilias
I
Cagiannos
Daniel Yick Chin
DY
Heng
Anil
A
Kapoor
Christian K
CK
Kollmannsberger
Forough
F
Mohammadzadeh
Ronald B
RB
Moore
Ricardo A
RA
Rendon
Denis
D
Soulieres
Simon
S
Tanguay
Peter
P
Venner
Michael
M
Jewett
Antonio
A
Finelli
D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000628:therapy; D003697:Delphi Technique; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care