How to improve breast cancer care measurement and reporting: suggestions from a complex urban hospital.

Increasing scrutiny of clinical data reporting by healthcare accrediting organizations is challenging hospitals to improve measurement and reporting, especially in the area of cancer care. We sought to explore barriers to breast cancer adjuvant treatment measurement and reporting to a hospital tumor registry (TR) and to identify opportunities to improve these processes. We conducted 31 key informant interviews with administrators and clinicians associated with a large urban hospital that treats a high volume of breast cancer patients. In this setting, up to 40 percent of early-stage breast cancer cases are treated by community-based oncologists, but reporting to the hospital's TR has been problematic. We asked about barriers to treatment measurement and reporting and sought suggestions to improve these processes. We used deductive and inductive methods to analyze interview transcripts. We found seven management barriers to adjuvant treatment measurement and reporting: process complexity, limited understanding of TR reporting, competing priorities, resource needs, communications issues, lack of supporting information technologies (IT), and mistrust of management. The four facilitators of measurement and reporting we noted were increasing awareness, improving communications and relationships, enhancing IT, and promoting the value of measurement and reporting. Four factors deemed critical to successful improvements were organizational commitment, leadership support, resources, and communication. Organizations striving to improve cancer care quality must overcome key barriers, especially those involving gaps in understanding and communication. In practice, hospitals should make explicit efforts to educate physicians and administrators about the importance of treatment reporting and to improve communications between the hospital's TR and physicians to ensure that needed adjuvant therapies are appropriately delivered.