Implementing quality metrics in European Cancer Centers (ECCs).

Since 2014, prostate cancer centers outside Germany (PCCoG) are eligible for certification according to the criteria set out by the German Cancer Society (DKG). These centers must fulfill the same requirements as their German counterparts. The article reports on the experiences of the first nine certified PCCoG, with a focus on their indicator results. Following a descriptive analysis about primary case distribution, indicator definitions, and patient numbers, we compared indicator results for all 114 German PCC with all 9 PCCoG that have been certified for at least 3 years. Median centers' proportion was calculated and overall proportion for every indicator. Two-sided Cochran-Armitage tests were applied to detect trends over time. The number of primary cases increased for both groups steadily from 2015 to 2017 as did fulfillment of most other indicators including PCa guideline-derived indicators. Requirements that proved to be hard to fulfill for PCCoG initially included psycho-oncological services (POS) and social service counselling (SCC). Fulfillment of POS requirements improved in the following years after initial certification in PCCoG. SCC rates remain low in PCCoG due to the different health system structures. Acquiring a certificate by the DKG is achievable for PCCoG. Candidate centers need to be aware that substantial effort is required to fulfill the criteria, but once this is done, typically an improvement of indicators and an increase in patient numbers can be observed. Different health-care systems need to be taken into consideration and the certification requirements adapted in different areas to allow country-specific implementation.