Degree of Variability in Performance on Breast Cancer Quality Indicators: Findings From the Florida Initiative for Quality Cancer Care

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

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Florida Initiative for Quality Cancer Care: Improvements in Breast Cancer Quality Indicators During a 3-Year Interval

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.03.063 ◽

2014 ◽

Vol 219 (4) ◽

pp. 638-645.e1 ◽

Cited By ~ 6

Author(s):

Christine Laronga ◽

Jhanelle E. Gray ◽

Erin M. Siegel ◽

Ji-Hyun Lee ◽

William J. Fulp ◽

...

Keyword(s):

Breast Cancer ◽

Quality Indicators ◽

Cancer Care ◽

Quality Cancer Care

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Improving on National Quality Indicators of Breast Cancer Care in a Large Public Hospital as a Means to Decrease Disparities for African American Women

Breast Diseases A Year Book Quarterly ◽

10.1016/j.breastdis.2011.06.030 ◽

2011 ◽

Vol 22 (3) ◽

pp. 258-260

Author(s):

K.A. Dookeran

Keyword(s):

Breast Cancer ◽

African American ◽

African American Women ◽

Quality Indicators ◽

Cancer Care ◽

Public Hospital ◽

Breast Cancer Care ◽

American Women ◽

National Quality

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

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6545 ◽

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]

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Breast Cancer Care in Jordan

JCO Global Oncology ◽

10.1200/jgo.19.00279 ◽

2020 ◽

pp. 260-268 ◽

Cited By ~ 1

Author(s):

Hikmat Abdel-Razeq ◽

Asem Mansour ◽

Dima Jaddan

Keyword(s):

Breast Cancer ◽

Treatment Outcomes ◽

Cancer Care ◽

Multimodality Treatment ◽

Current Status ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Breast Cancer Care ◽

Quality Cancer Care ◽

Treatment Facilities

Breast cancer is the most common malignancy in Jordan and the third leading cause of cancer death after lung and colorectal cancers. Although the incidence of breast cancer in Jordan is lower than that in industrialized nations, the number of new cases has been significantly increasing, and women present with breast cancer at a younger age and with more advanced disease than women in Western countries. Jordan is a medium-income country with limited resources and a young population structure. Therefore, breast cancer poses a particularly challenging burden on the country’s health care system. Despite ongoing endeavors to improve breast cancer care at both public and private levels, more work is needed to achieve downstaging of the disease and improve access, awareness, and participation in early detection. Multimodality treatment facilities and supportive care are available; however, the quality of care varies widely according to where the patient is treated, and most treatment facilities remain located centrally, thus, creating access difficulties. The King Hussein Cancer Center, the only comprehensive cancer center in Jordan, has changed the practice of oncology in the country via implementation of a multidisciplinary approach to treatment, monitoring of treatment outcomes, and investments in ongoing cancer research. However, there remains no national system for ensuring provision of high-quality cancer care nationwide. Here, we review the epidemiology of breast cancer and the current status of breast cancer care in Jordan, we compare our treatment outcomes with international ones, and we highlight challenges and improvement opportunities.

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