title: Quality Indicators to Assure and Improve Cancer Care in Spain Using the Delphi Technique.
abstract: The quality of cancer care has become a priority for health care systems. The goal of this research was to develop a set of evidence-based quality indicators (QIs) for organization, palliative care, and colorectal, breast, and lung cancers for introducing a system of benchmarking in Spain.
  
  
  
  A comprehensive evidence-based literature search was performed to identify potential QIs. An expert panel (the health care quality promotion group) of 9 oncologists identified indicators and evaluated them. A Delphi process involving 58 physicians was used to rank QIs by clinical relevance (validity). The expert panel then evaluated the selected indicators in terms of the feasibility of measuring them in Spanish hospitals, their usefulness for comparisons, their degree of clinical relevance, and their sensitivity to the impact of health care improvements.
  
  
  
  From the literature review, 99 potential QIs were identified. The Delphi process shortened the list to 72 QIs. A final set of 57 QIs was established by the health care quality promotion group: 12 related to organizational issues, 11 to colorectal cancer, 11 to breast cancer, 12 to lung cancer, and 11 to palliative care. This final set included structure (n=2), process (n=36), and outcome (n=19) indicators.
  
  
  
  A set of QIs has been developed using a validated Delphi method, meaning that we can be confident of their validity, feasibility, sensitivity, and acceptability. These QIs are to serve as the basis of a strategy for benchmarking across oncology services in Spanish hospitals and should enable us to assure and improve the quality of cancer care.
authors.affiliation: Consorci Hospital General Universitari València, València, Spain
authors.forename: Carlos
authors.initials: C
authors.lastname: Camps
authors.affiliation: Hospital del Mar, Barcelona, Spain
authors.forename: Joan
authors.initials: J
authors.lastname: Albanell
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, Spain
authors.forename: Antonio
authors.initials: A
authors.lastname: Antón
authors.affiliation: Maimónides Institute of Biomedical Research, Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
authors.forename: Enrique
authors.initials: E
authors.lastname: Aranda
authors.affiliation: Hospital Universitario Ramón y Cajal, Madrid, Spain
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.affiliation: Hospital Universitario de Guadalajara, Guadalajara, Spain
authors.forename: Javier
authors.initials: J
authors.lastname: Cassinello
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain
authors.forename: Daniel
authors.initials: D
authors.lastname: Castellano
authors.affiliation: Hospital Salamanca, Salamanca, Spain
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Cruz
authors.affiliation: Consorci Hospital General Universitari València, València, Spain
authors.forename: Pilar
authors.initials: P
authors.lastname: Garrido
authors.affiliation: Instituto Valenciano de Oncología, Valencia, Spain
authors.forename: Vicente
authors.initials: V
authors.lastname: Guillem
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain
authors.forename: Cristina
authors.initials: C
authors.lastname: Grávalos
authors.affiliation: Hospital Universitario de Cruces, Barakaldo, Spain
authors.forename: Guillermo
authors.initials: G
authors.lastname: López
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain
authors.forename: César
authors.initials: C
authors.lastname: Llorente
authors.affiliation: Hospital Puerto Real, Cádiz, Spain
authors.forename: Antonio
authors.initials: A
authors.lastname: Lorenzo
authors.affiliation: Hospital Clínico Universitario, Valencia, Spain
authors.forename: Ana
authors.initials: A
authors.lastname: Lluch
authors.affiliation: Universidad de Cádiz, Cádiz, Spain|Sociedad Española de Calidad Asistencial, Madrid, Spain
authors.forename: Emilio
authors.initials: E
authors.lastname: Ignacio
authors.affiliation: Hospital Universitario Clínica San Carlos, Madrid, Spain
authors.forename: Eduardo
authors.initials: E
authors.lastname: Díaz-Rubio
mesh_terms: D000368:Aged; D003697:Delphi Technique; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D019984:Quality Indicators, Health Care / Q000639:trends*; D013030:Spain