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The OECI certification/designation program: the Genoa experience

Abstract

Accreditation and designation procedures by the Organisation of European Cancer Institutes (OECI) have represented a considerable challenge for most of the Italian cancer centers. We summarize the experience of the San Martino-IST in Genoa, which, on the whole, was satisfactory, albeit demanding for the staff. The reorganization of most oncology/hematology operations within the disease management teams was probably the key point that allowed us to obtain approval as it brought about the possibility of bringing in uniform methods of diagnosis/treatment, increasing patient recruitment in clinical trials, and fostering translational research by promoting collaboration between clinicians and laboratory investigators. The creation of a more cohesive supportive and terminal care team facilitated both the OECI procedures as well as the operations within the institution. Finally, some considerations are added to the doctor and nurse management roles in Italian hospitals characterized by noticeable differences from northern Europe. These differences may represent an extra challenge for hospital management and evaluator teams more used to the northern European type of organization.

Tumori 2015; 101(Suppl. 1): 19 - 20

Article Type: REVIEW

DOI:10.5301/tj.5000457

Authors

Giovanni Orengo, Paolo Pronzato, Manlio Ferrarini

Article History

Disclosures

Financial support: This work was financially supported by the Ministry of Health-Italian Government within the Finalized Research Project Code: RF-2009-1532731. (Coord.: A. Paradiso, F. Belardelli).
Conflict of interest: the authors declare no conflict of interest.

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Introduction

The quality of care provided by cancer centers is a key issue for the European Union. If we aim at a uniform ­European health system, with the same level of medical assistance throughout the different EU countries, a third party specialist team should be in charge of evaluating the performance of the different institutions (1).

In 2012, there were 11 cancer centers officially certified by the Ministry of Health in Italy. At that time, debates on how to compare the quality/efficiency of the Italian centers to the European cancer centers/institutes were held. The Organisation of European Cancer Institutes (OECI) was recognized as the major organization capable of providing an independent and qualified assessment.

With this in mind, the Italian Ministry of Health, with its “Istituto Superiore di Sanità,” launched a program aimed at submitting all the Italian recognized cancer centers to the OECI accreditation/designation program (A&D).

Participation in the OECI A&D represents a challenging task for any European cancer center. For our institution, this task was especially challenging, given the fact that the San Martino-IST was created just 2 years before the initiative of the Italian Ministry of Health took place, by the decision to merge the San Martino-University Hospital with the Istituto Nazionale per la Ricerca sul Cancro (IST), both located in the same hospital area. The OECI certification manual states that merging may affect certification acquisition or even prevent it.

This article is not meant to describe our experience in detail, but to underline some specific aspects that can be helpful for institutes and European cancer centers preparing for the OECI certification process.

Disease management team organization

As soon as we received notice from the Istituto Superiore di Sanità confirming Italian participation in the OECI A&D, our key question was “Where do we start from in the institute?” It was clear that we needed to select a core subject around which all of the subsequent steps could be built. The solution of this problem was represented by disease management team (DMT) formation. Table I lists the DMTs now present in the institute; Table II shows all the DMT functions. The DMTs are composed of multidisciplinary teams of specialists that participate in the diagnosis/treatment of patients. The first duty of DMTs is defining the pathways of diagnosis and treatment (PDTA) of the single major types of tumors. These PDTA, although already existing in the 2 institutions before the merger, were not uniform and needed standardization (2). The second DMT duty is providing defined guidelines for each tumor, again with the scope of adopting a uniform methodology of diagnosis/treatment. The DMT strategy permitted the recruitment of preexisting staff from the 2 institutions who were placed in a new environment with a new type of organization. This allowed expansion of the DMT functions. For example, the DMTs have gradually become responsible for the organization/selection of clinical trials, which is currently bringing in many simplification elements including considerations on the number of patients for recruitment, as well as the potential working forces available. Finally, the DMTs were organized to include a number of laboratory investigators to foster cooperation and promote translational research that could profit from the large number of patient samples. This has proven particularly useful in the organization of those studies intended to define the genetic organization of tumors from large cohorts of patients using NGS technologies.

Disease management team disciplines

Breast
Lung
Gastrointestinal
Melanoma
Head and neck
Nervous system
Lymphoma

Disease management team aims

Guidelines identification
Pathways of diagnosis and treatment definition
Cases discussion
Complication registry
Annual report and monitoring of oncology activity
Teaching and education
Research: clinical trial enrollment
Collection of specimens for translational research

Supportive and palliative care team

Another issue that became evident in the preparation of the peer review process was represented by the need for reorganization of palliative care in the institute (3). As shown in Table III, all the subspecialties involved were present, although a more stringent coordination had to be enforced. To this end, the head of the emergency department was appointed as acting coordinator of the team. This move also allowed a comprehensive solution to the problem of oncology patients presenting to the emergency department with oncology problems/complications, thus providing stable continuity of care.

Supportive care team

Subspecialties: clinical nutrition, odontostomatology, phoniatrics, hospice and palliative care, pain care, oncology rehabilitation, psychology, psychiatry
Functions: early supportive and palliative needs identification, simultaneous care, case discussion during disease management team and general inpatient care meetings, holistic approach to the oncology patient

General organization

Another topic that became noticeable during the preparation for the A&D procedures, particularly during the OECI site visit, is the Italian approach towards patient management, which is mostly by doctors. In other countries, particularly those in northern Europe, nurses have major roles in patient management, under the supervision of doctors. This distinction highlights different approaches that may dictate different procedures. This Italian attitude seems to be shared by other countries in southern Europe and should be taken into account by the OECI reviewers.

Conclusion

The concept of standardization of procedures and care comes primarily from the United States experience, where a uniformity of approaches has been achieved. There, differences in diagnosis/treatment may be dictated by economic considerations and by guidelines of insurance companies. In Europe, wide differences in medical traditions have brought about variations concerning the general organization and the cultural approach to medicine.

Because of the heterogeneous background and cultural, political, and economic differences among EU countries, it will be more difficult to guarantee all our patients the desired uniformity of care and reduce inequalities. In this respect, initiatives such as the OECI A&D are important.

Acknowledgment

Supported by funding from the Italian Ministry of Health, Ricerca Finalizzata Project RF-2009-1532731.

Disclosures

Financial support: This work was financially supported by the Ministry of Health-Italian Government within the Finalized Research Project Code: RF-2009-1532731. (Coord.: A. Paradiso, F. Belardelli).
Conflict of interest: the authors declare no conflict of interest.
References
  • 1. Borras JM Albreht T Audisio R et al; European Partnership Action Against Cancer consensus group. Policy statement on multidisciplinary cancer care. Eur J Cancer 2014 50 3 475 480 Google Scholar
  • 2. Friedland PL Bozic B Dewar J Kuan R Meyer C Phillips M Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer 2011 104 8 1246 1248 Google Scholar
  • 3. Temel JS Greer JA Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010 363 8 733 742 Google Scholar

Authors

Affiliations

  • IRCCS AOU San Martino-IST, Genoa - Italy

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