Hirofumi Mukai1, Takahiro Higashi2, Masaoki Sasaki1, Tomotaka Sobue3. 1. Department of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan. 2. Division of Health Services Research, Center for Cancer Control and information Service, National Cancer Center, Tokyo, Japan. 3. Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Abstract
OBJECTIVE: The purpose of this study is to measure adherence rate to the quality indicators (QI) in clinical practice to evaluate the quality of care for breast cancer patients in Japan. DESIGN: A retrospective record review. SETTING: Two hundred twenty-four designated breast cancer care hospitals throughout Japan. PARTICIPANTS: A total of 15 227 patients diagnosed with breast cancer in 2005. MAIN OUTCOME MEASURES: The adherence rate of seven items that correspond to QIs of medical care, which were developed using an adaptation of RAND/UCLA (University of California, Los Angeles) appropriateness method. RESULTS: The lowest quality score was the drug therapy adherence to the St. Gallen consensus recommendations, for which the overall quality score 52.8%. The highest quality score was the adherence rate of hormone receptor testing, for which overall quality score was 97.8%. The greatest variations across facilities were for HER-2 testing and for radiation therapy after breast-conserving surgery. The least variation was for hormone receptor testing. CONCLUSIONS: There was a range of measurements for the adherence rate to each QI, suggesting that the desired standards of care had not necessarily pervaded all facilities. It is necessary to strive for widespread implementation of QIs and realization of the significance of measuring the medical care quality among physicians treating breast cancer.
OBJECTIVE: The purpose of this study is to measure adherence rate to the quality indicators (QI) in clinical practice to evaluate the quality of care for breast cancerpatients in Japan. DESIGN: A retrospective record review. SETTING: Two hundred twenty-four designated breast cancer care hospitals throughout Japan. PARTICIPANTS: A total of 15 227 patients diagnosed with breast cancer in 2005. MAIN OUTCOME MEASURES: The adherence rate of seven items that correspond to QIs of medical care, which were developed using an adaptation of RAND/UCLA (University of California, Los Angeles) appropriateness method. RESULTS: The lowest quality score was the drug therapy adherence to the St. Gallen consensus recommendations, for which the overall quality score 52.8%. The highest quality score was the adherence rate of hormone receptor testing, for which overall quality score was 97.8%. The greatest variations across facilities were for HER-2 testing and for radiation therapy after breast-conserving surgery. The least variation was for hormone receptor testing. CONCLUSIONS: There was a range of measurements for the adherence rate to each QI, suggesting that the desired standards of care had not necessarily pervaded all facilities. It is necessary to strive for widespread implementation of QIs and realization of the significance of measuring the medical care quality among physicians treating breast cancer.