Improving breast cancer care through a regional quality collaborative

Area of Science:

• Oncology
• Surgical Quality Improvement
• Health Services Research

Background:

• Regional collaborative organizations enhance surgical care quality.
• Breast cancer surgery quality measurement benefits from process measures due to low complication rates and long outcome latency.
• Diagnostic biopsy technique is a measurable and modifiable aspect of breast cancer care.

Purpose of the Study:

• To analyze institutional variation in surgical versus core needle biopsy use for initial breast cancer diagnosis within a regional quality collaborative.
• To assess the impact of data dissemination and collaborative efforts on biopsy practices.

Main Methods:

• Utilized data from the Michigan Breast Oncology Quality Initiative (MiBOQI), a collaborative of 18 hospitals, from November 2006 to December 2009.
• Collected and analyzed procedural data for 8,066 breast cancer patients, categorizing diagnostic biopsies as core needle or various surgical types.
• Shared aggregate, blinded data on biopsy techniques with site directors to facilitate practice pattern observation and targeted interventions.

Main Results:

• Initially, 21% of patients underwent surgical biopsy for diagnosis, with significant institutional variation (8%-37%).
• Patients with ductal carcinoma in situ were more likely to receive surgical biopsy (30.4%) compared to invasive cancer (17.8%).
• Following data sharing and consensus on a <15% target rate, the collaborative's surgical biopsy rate decreased to 15% over the study period.

Conclusions:

• Regional quality collaboratives are effective in collecting, analyzing, and disseminating surgical breast care data.
• These models facilitate the description of care patterns, inter-institutional comparisons, and the establishment of regional quality standards.
• Physician-led quality improvement initiatives, informed by collaborative data, can successfully modify practice patterns.