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JACIE accreditation status and outcome after hematopoietic stem cell transplantation

      Increasing resources are devoted to quality management systems (QMS) in healthcare. Studies searching for an impact on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic HSCT with each phase of the JACIE accreditation process. We tested whether working towards achieving JACIE acreditation accelerates improvement in outcome over calendar time. In a retrospective cohort analysis of 41,623 and 66,281 recipients of allogeneic or autologous HSCT from 1999 to 2006, we looked for an association of outcome with the transplant team accreditation status at time of transplant. Primary outcome was overall survival at 72 months, analyzed by an extended COX proportional hazards model. Confounders, cluster or stratification variables included disease type, EBMT risk score, age, donor type, conditioning, calendar year, centre, centre size, and Gross National Income per capita (GNI/cap) of the center's country. Overall survival, non-relapse mortality and relapse incidence improved stepwise from baseline (N= 33,753; HR=1) over the preparatory (N= 4,890; HR 0.90; 0.85 to 0.96) and application period (N= 1,922; HR 0.87; 0.80 to 0.95) to the accreditation period (N= 1,058; HR 0.87; 0.77 to 0.98) after an allogeneic HSCT, and were better at 72 months for the 49, 459 patients transplanted in the 162 JACIE- accredited centers compared to the 58,445 patients in 423 unaccredited centers in November 2012. Overall mortality declined over the 14 years observation period by a factor of 0.67 per 10 years (HR: 0.67; 0.62-0.73). Improvement was significantly faster in accredited than in non-accredited centers. No effect of JACIE accreditation was seen for autologous HSCT. Patients in larger centers had a significantly better overall survival, as did patients from countries with higher GNI/cap. Data show the complex association of macroeconomic factors with outcome after HSCT. They support the use of a QMS for other complex medical procedures.
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