Development Of Quality Indicators For Non-Hodgkin Lymphoma

17017 Background: Indicator development to monitor quality of care for non-Hodgkin lymphoma's (NHL) is difficult because NHL represents variable disorders with different and fast changing treatment policies. This study aimed to generate a set of valid indicators for NHL, using a systematic consensus method. Methods: Recommendations from evidence-based guidelines were collected as potential indicators. A multidisciplinary panel of 14 experts rated and discussed these recommendations on the usefulness as an indicator in three rounds using the Rand-modified Delphi procedure. This procedure was innovated with a flow chart from diagnostics to follow-up that showed which recommendations were crucial for the continuation of the care process. Experts were enforced to develop indicators for diagnostics, treatment and follow-up and the organization of care. Results: From a list of 99 recommendations 10 potential indicators for diagnostics, 10 for treatment and follow-up and 8 for the organization of care were selected. All potential indicators for diagnostics and treatment were crucial according to the flow chart. Six indicators were relevant for only a few patients and were rejected. Another six were merged into two. For diagnostics 8 indicators remained including taking a biopsy, evaluation of morphology and immune phenotype, the World Health Organization- classification, staging with CT-scanning of neck, thorax and abdomen, bone marrow aspirate and crista biopsy according to Ann Arbor, blood counts and the International Prognostic Index. For treatment 3 indicators remained regarding treatment with R-CHOP in optimal dose intensity for diffuse large B-cell lymphoma and response evaluation according to Cheson. For organization of care 7 indicators remained including waiting times, multidisciplinary consultations, adequate reporting and accredited expertise and facilities. Conclusions: This study showed that relevant quality indicators can be developed for a complex malignancy like NHL. Our innovations with the flow chart made a relevant contribution to the selection method and we managed to develop indicators for each part of the care process. They are currently tested for validity and feasibility. The use of these indicators makes it possible to monitor and improve the quality of care for NHL. No significant financial relationships to disclose.