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Use of the quality management system “JACIE” and outcome after hematopoietic stem cell transplantation.

Alois Gratwohl (1), Ronald Brand (2), Eoin McGrath (3), Anja van Biezen (2), Anna Sureda (4), Per Ljungman (5), Helen Baldomero (6), Christian Chabannon (7), and Jane Apperley (8), for the Joint Accreditation Committee (JACIE) of the International Society for Cellular Therapy and the European Group for Blood and Marrow Transplantation, and the European Leukemia Net.

Haematologica. 2014 May;99(5):908-15.

1Hematology, Medical Faculty, University of Basel, Switzerland
2Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
3JACIE Accreditation Office, Barcelona, Spain
4Department of Haematology, Addenbrookes Hospital, Cambridge, UK
5Department of Hematology Karolinska University Hospital, and Division of Hematology, Division of Medicine Huddinge, Karololinska Institutet, Stockholm, Sweden
6EBMT Activity Survey Office, University Hospital, Basel, Switzerland
7Cell Therapy Facility & Inserm CBT 510, Institut Paoli Calmettes, Marseille, France
8Haematology, Hammersmith Hospital, London, UK

 

Abstract

 

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneichematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system “JACIE”. We therefore tested the hypothesis that working towards and achieving “JACIE” accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering “JACIE”-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in “JACIE”-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 “JACIE”-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management systemtriggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stemcell transplantation. Our data support the use of a quality management system for complex medical procedures.

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About JACIE:

The Joint Accreditation Committee-ISCT (Europe) & EBMT (JACIE) is a non-profit body established in 1998 for the purposes of assessment and accreditation in the field of haematopoietic stem cell (HSC) transplantation. JACIE’s primary aim is to promote high quality patient care and laboratory performance in haematopoietic stem cell collection, processing and transplantation centres through an internationally recognised system of accreditation.

More information about JACIE 

 

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