Abstract：
OBJECTIVE: With expansion of academic cancer center networks across geographically-dispersed sites, ensuring high-quality delivery of care across all network affiliates is essential. We report on the characteristics and efficacy of a radiation oncology peer-review quality assurance (QA) system implemented across a large-scale multinational cancer network.
METHODS: Since 2014, weekly case-based peer-review QA meetings have been standard for network radiation oncologists with radiation oncology faculty at a major academic center. This radiotherapy (RT) QA program involves pre-treatment peer-review of cases by disease site, with disease-site subspecialized main campus faculty members. This virtual QA platform involves direct review of the proposed RT plan as well as supporting data, including relevant pathology and imaging studies for each patient. Network RT plans were scored as being concordant or nonconcordant based on national guidelines, institutional recommendations, and/or expert judgment when considering individual patient-specific factors for a given case. Data from January 1, 2014, through December 31, 2019, were aggregated for analysis.
RESULTS: Between 2014 and 2019, across 8 network centers, a total of 16,601 RT plans underwent peer-review. The network-based peer-review case volume increased over the study period, from 958 cases in 2014 to 4,487 in 2019. A combined global nonconcordance rate of 4.5% was noted, with the highest nonconcordance rates among head-and-neck cases (11.0%). For centers that joined the network during the study period, we observed a significant decrease in the nonconcordance rate over time (3.1% average annual decrease in nonconcordance, P = 0.01); among centers that joined the network prior to the study period, nonconcordance rates remained stable over time.
CONCLUSIONS: Through a standardized QA platform, network-based multinational peer-review of RT plans can be achieved. Improved concordance rates among newly added network affiliates over time are noted, suggesting a positive impact of network membership on the quality of delivered cancer care.
METHODS: Since 2014, weekly case-based peer-review QA meetings have been standard for network radiation oncologists with radiation oncology faculty at a major academic center. This radiotherapy (RT) QA program involves pre-treatment peer-review of cases by disease site, with disease-site subspecialized main campus faculty members. This virtual QA platform involves direct review of the proposed RT plan as well as supporting data, including relevant pathology and imaging studies for each patient. Network RT plans were scored as being concordant or nonconcordant based on national guidelines, institutional recommendations, and/or expert judgment when considering individual patient-specific factors for a given case. Data from January 1, 2014, through December 31, 2019, were aggregated for analysis.
RESULTS: Between 2014 and 2019, across 8 network centers, a total of 16,601 RT plans underwent peer-review. The network-based peer-review case volume increased over the study period, from 958 cases in 2014 to 4,487 in 2019. A combined global nonconcordance rate of 4.5% was noted, with the highest nonconcordance rates among head-and-neck cases (11.0%). For centers that joined the network during the study period, we observed a significant decrease in the nonconcordance rate over time (3.1% average annual decrease in nonconcordance, P = 0.01); among centers that joined the network prior to the study period, nonconcordance rates remained stable over time.
CONCLUSIONS: Through a standardized QA platform, network-based multinational peer-review of RT plans can be achieved. Improved concordance rates among newly added network affiliates over time are noted, suggesting a positive impact of network membership on the quality of delivered cancer care.
摘要：
目标：随着学术癌症中心网络在地理上分散的站点的扩展，确保所有网络分支机构的高质量护理交付至关重要。我们报告了在大型跨国癌症网络中实施的放射肿瘤学同行评审质量保证（QA）系统的特征和功效。
方法：自2014年以来，每周基于病例的同行评审QA会议已成为主要学术中心放射肿瘤学系的网络放射肿瘤学家的标准。该放射治疗（RT）QA计划涉及按疾病部位对病例进行的治疗前同行评审，与疾病现场亚专业的主要校园教职员工。该虚拟QA平台涉及对建议的RT计划的直接审查以及支持数据，包括每位患者的相关病理学和影像学研究。根据国家指南，网络RT计划被评分为一致或不一致，机构建议，和/或专家判断时考虑个别患者的特定因素为一个给定的案例。2014年1月1日至2019年12月31日的数据汇总用于分析。
结果：在2014年至2019年之间，跨8个网络中心，共有16,601个RT计划接受了同行评审.在研究期间，基于网络的同行评审病例量有所增加，从2014年的958例增加到2019年的4487例。注意到全球不一致率为4.5%，头颈部病例不一致率最高(11.0%)。对于在研究期间加入网络的中心，我们观察到不一致率随着时间的推移显著下降(不一致率平均每年下降3.1%，p=0.01)；在研究期之前加入网络的中心中，不一致率随着时间的推移保持稳定。
结论：通过标准化的QA平台，基于网络的跨国同行评审RT计划可以实现。随着时间的推移，新增加的网络分支机构之间的协调率有所提高，提示网络成员资格对癌症治疗质量的积极影响。
方法：自2014年以来，每周基于病例的同行评审QA会议已成为主要学术中心放射肿瘤学系的网络放射肿瘤学家的标准。该放射治疗（RT）QA计划涉及按疾病部位对病例进行的治疗前同行评审，与疾病现场亚专业的主要校园教职员工。该虚拟QA平台涉及对建议的RT计划的直接审查以及支持数据，包括每位患者的相关病理学和影像学研究。根据国家指南，网络RT计划被评分为一致或不一致，机构建议，和/或专家判断时考虑个别患者的特定因素为一个给定的案例。2014年1月1日至2019年12月31日的数据汇总用于分析。
结果：在2014年至2019年之间，跨8个网络中心，共有16,601个RT计划接受了同行评审.在研究期间，基于网络的同行评审病例量有所增加，从2014年的958例增加到2019年的4487例。注意到全球不一致率为4.5%，头颈部病例不一致率最高(11.0%)。对于在研究期间加入网络的中心，我们观察到不一致率随着时间的推移显著下降(不一致率平均每年下降3.1%，p=0.01)；在研究期之前加入网络的中心中，不一致率随着时间的推移保持稳定。
结论：通过标准化的QA平台，基于网络的跨国同行评审RT计划可以实现。随着时间的推移，新增加的网络分支机构之间的协调率有所提高，提示网络成员资格对癌症治疗质量的积极影响。
