Please use this identifier to cite or link to this item:
Title: Use of the quality management system 'JACIE' and outcome after hematopoietic stem cell transplantation
Author: Gratwohl, Alois
Brand, Roland
McGrath, Eoin
van Biezen, Anja
Sureda, Anna
Ljungman, Per
Baldomero, Helen
Chabannon, Christian
Apperley, Jane
Joint Accreditation Committee (JACIE)
International Society for Cellular Therapy
European Group for Blood and Marrow Transplantatio
European Leukemia Net
Keywords: Cèl·lules mare
Avaluació de resultats (Assistència mèdica)
Garantia de qualitat
Stem cells
Outcome assessment (Medical care)
Quality assurance
Issue Date: 1-May-2014
Publisher: Ferrata Storti Foundation
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 allogeneic hematopoietic 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 system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.
Note: Reproducció del document publicat a:
It is part of: Haematologica, 2014, vol. 99, num. 5, p. 908-915
Related resource:
ISSN: 0390-6078
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

Files in This Item:
File Description SizeFormat 
696172.pdf2.77 MBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.