National Quality Measures for Breast Centers (NQMBC): A Robust Quality Tool
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Measuring and improving quality of care is of primary interest to patients, clinicians, and payers. The National Consortium of Breast Centers (NCBC) has created a unique program to assess and compare the quality of interdisciplinary breast care provided by breast centers across the country.
In 2005 the NCBC Quality Initiative Committee formulated their initial series of 37 measurements of breast center quality, eventually called the National Quality Measures for Breast Centers (NQMBC). Measures were derived from published literature as well as expert opinion. An interactive website was created to enter measurement data from individual breast centers and to provide customized comparison reports. Breast centers submit information using data they collect over a single month on consecutive patients. Centers can compare their results with centers of similar size and demographic or compare themselves to all centers who supplied answers for individual measures. New data may be submitted twice yearly. Serially submitted data allow centers to compare themselves over time. NQMBC random audits confirm accuracy of submitted data. Early results on several initial measures are reported here.
Over 200 centers are currently submitting data to the NQMBC via the Internet without charge. These measures provide insight regarding timeliness of care provided by radiologists, surgeons, and pathologists. Results are expressed as the mean average, as well as 25th, 50th, and 75th percentiles for each metric. This sample of seven measures includes data from over 30,000 patients since 2005, representing a powerful database. In addition, comparison results are available every 6 months, recognizing that benchmarks may change over time.
A real-time web-based quality improvement program facilitates breast center input, providing immediate comparisons with other centers and results serially over time. Data may be used by centers to recognize high-quality care they provide or to identify areas for quality improvement. Initial results demonstrate the power and potential of web-based tools for data collection and analysis from hundreds of centers who care for thousands of patients.
- National Cancer Policy Board, Institute of Medicine and Commission on Life Sciences. Ensuring Quality Cancer Care, National Academy Press, 1999. http://books.nap.edu/openbook.php?record_id=6467&page=R1. Accessed February 22, 2009.
- Centers for Medicare and Medicaid Services, Physician Quality Reporting Initiative. http://www.cms.hhs.gov/PQRI/01_Overview.asp#TopOfPage. Accessed February 22, 2009.
- The LeapFrog Group for Patient Safety. http://www.leapfroggroup.org/home.
- American College of Surgeons, National Surgical Quality Improvement Program. https://acsnsqip.org/login/default.aspx. Accessed February 22, 2009.
- Centers for Medicare and Medicaid Services, Physician Quality Reporting Initiative 2009 PQRI Measures List. http://www.cms.hhs.gov/PQRI/Downloads/2009PQRIMeasuresList.pdf. Accessed February 22, 2009.
- Society of Thoracic Surgeons, STS National Database. http://www.sts.org/sections/stsnationaldatabase/. Accessed February 22, 2009.
- Perkins C, Balma D, Garcia R; Members of the Consensus Group; Susan G. Komen for the Cure. Why current breast pathology practices must be evaluated. A Susan G. Komen for the Cure white paper: June 2006. Breast J. 2007;13:443–7.
- Malin, J, Schneider, EC, Epstein, AM, Adams, J, Emanuel, EJ, Kahn, KL (2006) Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?. J Clin Oncol 24: pp. 626-634 CrossRef
- Neumayer, L, Hosokawa, P, Itani, K, El-Tamer, M, Henderson, WG, Khuri, SF (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204: pp. 1178-1187 CrossRef
- Khuri, SF, Henderson, WG, Daley, J, Jonasson, O, Lones, RS, Campbell, DA (2008) Successful implementation of the Department of Veterans Affairs” National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery Study. Ann Surg 248: pp. 329-336 CrossRef
- Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Institute of Medicine of the National Academies, Executive Summary. Rewarding Provider Performance: Aligning Incentives in Medicare. The National Academies Press, Sept 2006. http://www.nap.edu/catalog/11723.html. Accessed February 20, 2009.
- Hoy, E (2008) Measuring patient experiences of care. Bull Am Coll Surg 93: pp. 13-16
- Sharp, BA, Meikle, SF, James, MD, Steiner, C, Remus, D (2005) NHQR/NHDR measures for women of reproductive age. Med Care 43: pp. 164-171 CrossRef
- Andersen, MR, Bowen, DJ, Morea, J, Stein, KD, Baker, F (2009) Involvement in decision-making and breast cancer survivor quality of life. Health Psychol 28: pp. 29-37 CrossRef
- Waljee, JF, Hawley, S, Alderman, AK, Morrow, M, Katz, SJ (2007) Patient satisfaction with treatment of breast cancer: does surgeon specialization matter?. J Clin Oncol 25: pp. 3694-3698 CrossRef
- The Advisory Board Company. http://www.advisoryboardcompany.com/index.html. Accessed February 22, 2009.
- National Consortium of Breast Centers, Breast Center Types and Criteria. http://www.breastcare.org/. Accessed February 22, 2009.
- National Quality Measures for Breast Centers. Benefits of participation. http://www.nqmbc.org. Accessed February 22, 2009.
- Zarbo, RJ, Gephardt, GN, Howanitz, PJ (1996) Intralaboratory timeliness of surgical pathology reports. Results of two College of American Pathologists Q-Probes studies of biopsies and complex specimen. Arch Pathol Lab Med 120: pp. 234-244
- Novis, DA, Zarbo, RJ, Saladino, AJ (1998) Interinstitutional comparison of surgical biopsy diagnosis turnaround time: a College of American Pathologists Q-Probes study of 5384 surgical biopsies in 157 small hospitals. Arch Pathol Lab Med 122: pp. 951-956
- Nakhleh, RE, Jones, B, Zarbo, RJ (1997) Mammographically directed breast biopsies: a College of American Pathologists Q-Probes study of clinical physician expectations and of specimen handling and reporting characteristics in 434 institutions. Arch Pathol Lab Med 121: pp. 11-18
- Buyske, J (2009) For the protection of the public and the good of the specialty: Maintenance of certification. Arch Surg 144: pp. 101-103 CrossRef
- Williams, SC, Schmaltz, SP, Morton, DJ, Koss, RG, Loeb, JM (2005) Quality of care in U.S. hospitals as reflected by standardized measures, 2002–2004. N Engl J Med 353: pp. 255-264 CrossRef
- Lindenauer, PK, Remus, D, Roman, S, Rothberg, MB, Benjamin, EM, Ma, A (2007) Public reporting and pay for performance in hospital quality improvement. N Engl J Med 356: pp. 486-496 CrossRef
- Mainz, J (2003) Defining and classifying clinical indicators for quality improvement. Int J Quality Health Care 15: pp. 523-530 CrossRef
- Donaldson M, ed. Measuring the quality of health care: a statement by the National Roundtable on Health Care Quality. Washington, DC: National Academy; 1999.
- Kaufman, CS (2004) Breast care is a team sport. Breast J 10: pp. 469-472 CrossRef
- Tisnado, DM, Rose-Ash, DE, Malin, JL, Adams, JL, Ganz, PA, Kahn, KL (2008) Financial incentives for quality in breast cancer care. Am J Manag Care 14: pp. 457-466
- Rosenthal, MB, Frank, RG, Li, Z, Epstein, AM (2005) Early experience with pay-for-performance: from concept to practice. JAMA 294: pp. 1788-1793 CrossRef
- Personal communication, Lillie Shockney RN, BS, MAS, May, 2005.
- Kothari, A, Fentiman, IS (2003) Diagnostic delays in breast cancer and impact on survival. Int J Clin Pract 57: pp. 200-203
- Burack, RC, Simon, MS, Stano, M, George, J, Coombs, J (2000) Follow-up among women with an abnormal mammogram in an HMO: is it complete, timely, and efficient?. Am J Manag Care 6: pp. 1102-1113
- Olivotto, IA, Kan, L, King, S (2000) Waiting for a diagnosis after an abnormal screening mammogram. SMPBC diagnostic process workgroup. Screening Mammography Program of British Columbia. Can J Public Health 91: pp. 113-117
- Perez, G, Porta, M, Borrell, C, Casamitjana, M (2008) Interval from diagnosis to treatment onset for six major cancers in Catalonia, Spain. Cancer Detect Prev 32: pp. 267-275 CrossRef
- Psooy, BJ, Schreuer, D, Borgaonkar, J, Caines, JS (2004) Patient navigation: improving timeliness in the diagnosis of breast abnormalities. Can Assoc Radiol J 55: pp. 145-150
- Chang, SW, Kerlikowske, K, Napoles-Springer, A, Posner, SF, Sickles, EA, Perez-Stable, EJ (1996) Racial differences in timeliness of follow-up after abnormal screening mammography. Cancer 78: pp. 1395-1402 CrossRef
- Brucker SY, Schumacher C, Sohn C, et al. Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results (2003-2007) from Germany as a proof of concept”. BMC Cancer. 2008;8:358. http://www.biomedcentral.com/1471-2407/8/358. Accessed February 12, 2009.
- Mano MP, Distante V, Tomatis M, Baiocchi D, et al. Audit system on quality of breast cancer diagnosis and treatment (QT): results of quality indicators on screen-detected lesions in Italy in 2005 and preliminary results for 2006. Epidemiol Prev. 2008;32:77–84.
- Cheng, SH, Wang, CJ, Lin, JL, Horng, CF, Lu, MC (2009) Adherence to quality indicators and survival in patients with breast cancer. Med Care 47: pp. 217-225 CrossRef
- Chen CY, Tzeng WS, Tsai CC, Mak CW, Chen CH, Chou MC. Adjusting mammography-audit recommendations in a lower-incidence Taiwanese population. J Am Coll Radol. 2008;5:978–85.
- Feig, SA (2007) Auditing and benchmarks in screening and diagnostic mammography. Radiol Clin North Am 45: pp. 791-800 CrossRef
- Razavi AR, Gill H, Ahlfeldt H, Shahsavar N. Non-compliance with a postmastectomy radiotherapy guideline: Decision tree and cause analysis. BMC Med Informatics Decision Making. 2008;8:41–9.
- Olivotto, IA, Bancej, C, Goel, V, Snider, J, McAuley, RG, Irvine, B (2001) Waiting times form abnormal breast screen to diagnosis in 7 Canadian provinces. CMAJ 165: pp. 277-283
- Kaufman, CS, Delbecq, R, Jacobson, L (1998) Excising the re-excision: stereotactic core biopsy decreases need for re-excision of breast cancer. World J Surg 22: pp. 1023-1028 CrossRef
- Pocock, B, Taback, B, Klein, L, Joseph, KA, El-Tamer, M (2009) Preoperative needle biopsy as a potential quality measure in breast cancer surgery. Ann Surg Oncol 16: pp. 1108-11 CrossRef
- Clarke-Pearson, EM, Jacobson, AF, Boolbol, SK, Leitman, IM, Friedmann, P, Lavarias, V (2009) Quality assurance initiative at one institution for minimally invasive breast biopsy as the initial diagnostic technique. J Am Coll Surg 208: pp. 75-78 CrossRef
- Silverstein, MJ, Lagios, MD, Recht, A, Allred, DC, Harms, SE, Holland, R (2005) Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg 201: pp. 586-597 CrossRef
- Friese, CR, Neville, BA, Edge, SB, Hassett, MJ, Earle, CC (2009) Breast biopsy patterns and outcomes in Surveillance, Epidemiology, and End Results-Medicare data. Cancer 115: pp. 716-724 CrossRef
- Holloway, CM, Saskin, R, Paszat, L (2008) Geographic variation and physician specialization in the use of percutaneous biopsy for breast cancer diagnosis. Can J Surg 51: pp. 453-463
- Lannin, DR, Ponn, T, ANdrejeva, L, Philpotts, L (2006) Should all breast cancers be diagnosed by needle biopsy?. Am J Surg 192: pp. 450-454 CrossRef
- Kaufman, CS (2007) National quality validation programs for breast centers. Expert Rev Anticancer Therapy 7: pp. 1357-1362 CrossRef
- Yee KM. Exceeding ‘excellent’: how breast centers track quality. AuntMinnie.com February 17, 2009. http://www.auntminnie.com/index.asp?Sec=sup&Sub=imc&Pag=dis&ItemId=84615. Accessed February 18, 2009.
- Kaufman, CS (2007) Validating quality breast care: three new validation programs for 2007. Am J Surg 194: pp. 515-517 CrossRef
- American Society of Breast Surgeons. Mastery Program. http://www.breastsurgeons.org/MasteryProgram.html. Accessed February 22, 2009.
- American Society of Clinical Oncology. Quality Oncology Practice Initiative, QOPI. http://qopi.asco.org/program.html. Accessed February 22, 2009.
- American Society for Therapeutic Radiation Oncology. Performance Assessment for the Advancement of Radiation Oncology. http://asro.astro.org/PAAROT/Default.aspx. Accessed February 22, 2009.
- American Board of Surgery. Maintenance of Certification. http://home.absurgery.org/default.jsp?exam-moc. Accessed February 22, 2009.
- Winchester, DP (2008) The national accreditation program for breast centers: a multidisciplinary approach to improve the quality of care for patients with diseases of the breast. Breast J 14: pp. 409-411 CrossRef
- National Quality Measures for Breast Centers. Difference and Similarities: NAPBC and NQMBC. http://www.nqmbc.org/NAPBCandNQMBC.htm. Accessed February 22, 2009.
- American College of Surgeons. National Accreditation Program for Breast Centers, Program Standards/Components. http://www.accreditedbreastcenters.org/. Accessed February 22, 2009.
- National Quality Measures for Breast Centers (NQMBC): A Robust Quality Tool
Annals of Surgical Oncology
Volume 17, Issue 2 , pp 377-385
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- Author Affiliations
- 1. Bellingham Breast Center, University of Washington, Bellingham, WA, USA
- 2. Johns Hopkins Avon Foundation Breast Center, Baltimore, MD, USA
- 3. Meridian Health/Ocean Medical Center, Brick, NJ, USA
- 4. Coleman Breast Center Consultation Services, Tiburon, CA, USA
- 5. Baptist Hospital for Women, Memphis, TN, USA
- 6. Gundersen Lutheran Surgery Clinic, LaCrosse, WI, USA
- 7. Houston NW Hospital Breast Center, Houston, TX, USA
- 8. National Consortium of Breast Centers, Inc., Warsaw, IN, USA