High-Priority Areas for Quality Improvement Identified for Breast Cancer Treatment

Researchers identified three quality measures that have the largest potential of improving quality of care at a system level for patients with early-stage breast cancer receiving systemic therapy.

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Evaluating quality measures to identify gaps in care is necessary to improve cancer systems. Targeting quality improvement at quality measures that demonstrate significant variation has the highest likelihood of making the largest impact at the population level for patients with early-stage breast cancer.

Katherine A Enright, MD, MPH, FRCPC, University of Toronto (Canada), and colleagues attempted to identify priorities for improving the quality of systemic therapy for women with early-stage breast cancer. Researchers developed an approach that utilized both variation in performance and the number of patients impacted by the quality measures. A total of 28,427 patients from the Ontario Cancer Registry were sampled who were diagnosed with early-stage breast cancer from 2006 to 2010.

Individual quality measures within a panel of 15 measures developed previously to evaluate the quality of systemic therapy across multiple domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance and the number of patients who were impacted. These rankings were averaged for a summative priority ranking.

The study was published in Journal of Clinical Oncology (online July 6, 2017; doi:10.1200/JCO.2016.70.7950).

Results of this ranking approach yielded computerized physician electronic order entry for systemic chemotherapy, emergency room visits or hospitalizations during systemic therapy, and timely receipt of systemic therapy as the quality measures with the largest potential to improve quality of care at a system level for patients with early-stage breast cancer. “Targeted system-level quality improvement interventions in these areas may reduce institutional variation and result in improved patient outcomes,” researchers speculated.

Authors of the study concluded that a basic ranking system using interinstitutional variation in performance and patient volume can be used to identify high-priority measures for quality improvement from a population perspective. “Although the priorities that have been identified are specific to the Ontario Cancer System, the approach should be widely applicable and useful in any health care system that routinely uses quality measures to drive improvement,” they wrote.—Zachary Bessette