scholarly journals Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment

Cancer ◽  
2015 ◽  
Vol 122 (3) ◽  
pp. 420-431 ◽  
Author(s):  
Michael J. Hassett ◽  
Maria J. Schymura ◽  
Kun Chen ◽  
Francis P. Boscoe ◽  
Foster C. Gesten ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
Cancer Care ◽  
Care Quality ◽  
Breast Cancer Care ◽  
Medicaid Enrollment ◽  
Race Ethnicity

scholarly journals Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

2020 ◽  
pp. 1446-1454
Author(s):  
Lydia E. Pace ◽  
Lauren E. Schleimer ◽  
Cyprien Shyirambere ◽  
André Ilbawi ◽  
Jean Marie Vianney Dusengimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Delphi Process ◽  
Sub Saharan Africa ◽  
Breast Cancer Care ◽  
Modified Delphi ◽  
Sub Saharan

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

Standardizing quality breast cancer care throughout all New York university facilities.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 160-160
Author(s):  
Anna C. Pavlick ◽  
Freya Ruth Schnabel ◽  
Amy Tiersten ◽  
Matthew Volm ◽  
Jennifer J. Wu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
Cost Effectiveness ◽  
Cancer Care ◽  
Treatment Algorithm ◽  
Care Program ◽  
Cancer Center ◽  
Breast Cancer Care ◽  
New York University ◽  
Provider Satisfaction

160 Background: NYU physicians provide breast cancer care (BCC) at several locations throughout New York. The NYU Clinical Cancer Center (NYUCCC) is a private, university-based facility while Bellevue and Woodhull Hospitals are city hospitals. The diversity of BCC provided to patients (pts) in city hospitals can vary greatly from that of private centers and intra-center physician variability also diversifies care. This variability can impact on pt satisfaction and outcomes. Breast cancer (Br Ca) pts make up the greatest number of pts seen and treated at all NYU affiliated sites, therefore, a "Br Ca Quality of Care Program" will be incorporated into the electronic medical record (EMR) at all facilities. A treatment algorithm based on the pt’s stage and a simple "drop-down menus" will simplify use. It will encompass diagnostic imaging, pathology, biopsy procedures, surgery, radiation, chemo, and hormonal therapy as well as survivorship guidelines for maintaining wellness. Methods: Leaders of each Br Ca program have identified potential barriers to care and rectifiable issues. Algorithms and “drop down menus” in the EMR will be presented to the NYUCCC Br Ca physicians for feedback. This tool will then be refined and launched at NYUCCC. After evaluating this program at NYUCCC, the data will be presented to the all NYUCCC faculty. Achieving the city hospitals to adopt this EMR program will be the ultimate success and standardized quality care will be the result. Results: An assessment of the endpoints of physician adherence to guidelines, cost effectiveness and pt/provider satisfaction will be conducted 6 months later. Random audits of breast cancer pt charts will evaluate provider compliance. A cost analysis of this care will be done and compared to a random sampling of previously treated pt charts. Review and analysis of this data would be presented to the NYUCCC faculty, then programs launched at both city-hospitals. Conclusions: If the endpoints of quality standardized care, cost effectiveness and pt/provider satisfaction are met, incorporation of similar programs into other high volume oncologic disease entities seen at all NYU facilities would be developed.

Evaluation of quality measures for breast cancer care in a community setting

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6545-6545
Author(s):  
L. L. Dietrich ◽  
R. Ballandby ◽  
J. Lee ◽  
D. Sullivan ◽  
M. A. Mathiason ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
Quality Measures ◽  
Care Quality ◽  
Adherence Rate ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Nccn Guidelines ◽  
Guideline Compliance

6545 Background: Compliance with National Initiative for Cancer Care Quality (NICCQ) quality indicators and National Comprehensive Cancer Network (NCCN) guidelines for breast cancer care are proposed measures of quality breast cancer care. Previously, we had determined NCCN guideline compliance rates for breast cancer care by physician review of electronic medical record (EMR). In the present study, we sought to compare NCCN guideline compliance and NICCQ adherence at our institution in regard to percent compliance, time taken to complete review, and comparison of physician reviewer (PR) versus non-physician reviewer (NPR). Methods: Review of the EMR was conducted for all 200 female patients who were newly diagnosed with breast cancer and treated at our multi-specialty institution in 2004. A PR and a NPR reviewed compliance with NICCQ quality indicators and NCCN guidelines for breast cancer care and time spent reviewing charts was recorded. Results: Adherence rate was less than 85% in only 7 of 36 NICCQ breast cancer quality measures for PR and only 6 of 36 for NPR. Patients overall received 91.5 % of NICCQ recommended care according to PR and 89.8% according to NPR. NICCQ measures were divided into categories to correspond with NCCN guideline categories and results are compared and summarized in the table below. Differences in observed compliance rates between PR and NPR were not significant for NCCN (except in pre-op workup where NPR was more accurate) or overall NICCQ audit, however differences were seen in individual NICCQ items with small numbers of patients. Average time for review of charts for NCCN guideline compliance vs. NICCQ adherence was not significantly different (6.8 vs. 6.3 minutes for PR and 8.3 vs. 8.9 minutes for the NPR). Conclusions: Our adherence rates for NICCQ and NCCN measures compare favorably with published values. Despite both being proposed quality measures, comparison of adherence rates for the two systems varied. PR is slightly faster than NPR but offset by PR's time value. A NPR performs as well, if not better, than a PR. No significant financial relationships to disclose. [Table: see text]

scholarly journals Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

2019 ◽  
pp. 1-16
Author(s):  
Daniel S. O’Neil ◽  
Wenlong Carl Chen ◽  
Oluwatosin Ayeni ◽  
Sarah Nietz ◽  
Ines Buccimazza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
South African ◽  
Hormone Receptor ◽  
Cancer Care ◽  
Care Quality ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
Breast Cancer Care

PURPOSE The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.

Patient Navigation and the Quality of Breast Cancer Care: An Analysis of the Breast Cancer Care Quality Indicators

2012 ◽  
Vol 19 (10) ◽  
pp. 3251-3256 ◽  
Author(s):  
Joseph J. Weber ◽  
Debra C. Mascarenhas ◽  
Lisa S. Bellin ◽  
Rachel E. Raab ◽  
Jan H. Wong
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
Patient Navigation ◽  
Care Quality ◽  
Breast Cancer Care

scholarly journals Review of Quality Measures for Breast Cancer Care by Country Income Level

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 41s-41s ◽  
Author(s):  
Lauren E. Schleimer ◽  
Nancy L. Keating ◽  
Lawrence N. Shulman ◽  
Ben O. Anderson ◽  
Catherine Duggan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Web Sites ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Measures ◽  
Care Quality ◽  
High Income ◽  
Breast Cancer Care ◽  
Process Measures ◽  
Middle Income

Purpose Measurement of the quality of cancer care is essential for quality improvement and is widely implemented in oncology programs in high-income countries. Growing efforts are being made to measure care quality in emerging cancer care delivery systems in low- and middle-income countries (LMICs). This will require the development of measures that are clinically important, actionable, relevant to existing resources, and feasible to routinely evaluate. As part of a project to develop resource-adapted quality measures for Rwanda and other LMICs, we conducted a systematic review of the literature to identify published quality measures for the diagnosis and treatment of breast cancer. Methods We performed a literature search in accordance with PRISMA guidelines using the following terms in PubMed: ‘breast cancer’ and ‘quality indicator,’ ‘quality measure,’ or ‘quality metric’; and the following MeSH terms: ‘breast neoplasms’ and ‘healthcare quality indicator.’ We included English-language articles published before August 2017 that described the systematic identification of process measures for breast cancer diagnosis or treatment through literature review, clinical validation, and/or expert panel determination. We directly searched the Web sites of prominent cancer care organizations to identify additional publicly available measures. Income level was classified using World Bank definitions. Results We identified 521 published quality measures, including 419 measures from 27 peer-reviewed journal articles and 102 measures from the Web sites of national and international cancer care organizations. Twenty-five peer-reviewed publications (93%) originated from high-income countries, one from an upper-middle income country (People’s Republic of China), and one from the international Breast Health Global Initiative with process measures to assess the phased implementation of breast cancer services. No resources or articles other than that from the Breast Health Global Initiative provided suggestions for adapting measures to limited resources. Conclusion A large number of quality measures for breast cancer care have been identified and published in high-income countries; however, no breast cancer care quality measures have been systematically developed and validated for use in settings where resource limitations crucially affect care delivery and measurement feasibility. We are collaborating with clinicians in LMICs and global breast cancer experts to develop and validate quality measures that will enable quality improvement initiatives in Rwanda and other emerging cancer care delivery systems. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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