Nationwide quality improvement in lung cancer care: the role of the Danish Lung Cancer Group and Registry.
BACKGROUND
To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators.


METHODS
A wide range of indicators was established, validated, and monitored. By registration of all lung cancer patients since the year 2000, data on more than 40,000 patients have been included in the database. Results are reported periodically/quarterly and submitted to formal auditing on an annual basis.


RESULTS
Improvements in all outcome indicators are documented and statistically significant. Thus the 1-year overall survival rate has increased between 2003 and 2011 from 36.6% to 42.7%, the 2-year survival rate from 19.8% to 24.3%, and the 5-year survival rate from 9.8% to 12.1%. Five-year survival after surgical resection has increased from 39.5% to 48.1%. Improvements of waiting times, accordance between cTNM and pTNM, and resection rates are documented.


CONCLUSIONS
The Danish experience shows that a national quality management system including national guidelines, a database with high data quality, frequent reports, audit and commitment from all stakeholders can contribute to improve clinical practice, improve core results, and reduce regional differences.
*Leader of the Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark; †Odense Patient Data Exploratory Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; ‡Chairman of the Executive Committee and The Danish Lung Cancer Registry, Department of Oncology, Copenhagen University Hospital at Rigshospitalet, Copenhagen, Denmark; §Chairman of the Danish Lung Cancer Group 2012, Department of Pulmonary Medicine, Aarhus University Hospital, Aarhus, Denmark; ‖Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; and ¶Chairman of the Danish Lung Cancer Group and the NIP-project 2001-2012, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Erik
E
Jakobsen
Anders
A
Green
Kell
K
Oesterlind
Torben Riis
TR
Rasmussen
Maria
M
Iachina
Torben
T
Palshof
D003131:Combined Modality Therapy; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D003718:Denmark; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data*; D015996:Survival Rate