Megan E Miller1,2, Richard J Bleicher1,3, Cary S Kaufman1,4, Scott H Kurtzman1,5, Cecilia Chang1,6, Chi-Hsiung Wang1,6, Karen A Pollitt1,7, James Connolly1,8, David P Winchester1,9, Katharine A Yao10,11,12. 1. The Data Working Group, National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA. 2. Department of Surgery, Case Western Reserve University, University Hospitals, Cleveland, OH, USA. 3. Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA. 4. Department of Surgery, Bellingham Regional Breast Center, Bellingham, WA, USA. 5. Department of Surgery, University of Connecticut Health Center, Waterbury, CT, USA. 6. Division of Bioinformatics, Research Institute, NorthShore University HealthSystem, Evanston, IL, USA. 7. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA. 8. Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 9. Cancer Programs, American College of Surgeons, Chicago, IL, USA. 10. The Data Working Group, National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA. kyao@northshore.org. 11. Division of Bioinformatics, Research Institute, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org. 12. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org.
Abstract
PURPOSE: This study was designed to determine whether accreditation by the National Accreditation Program for Breast Centers (NAPBC) is associated with improved performance on six breast quality measures pertaining to adjuvant treatment, needle/core biopsy, and breast conservation therapy rates at Commission on Cancer (CoC) centers. METHODS: National Cancer Database 2015 data were retrospectively reviewed to compare patients treated at CoC centers with and without NAPBC accreditation for compliance on six breast cancer quality measures. Mixed effects modeling determined performance on the quality measures adjusting for patient, tumor, and facility factors. RESULTS: Of 1308 CoC facilities, 484 (37%) were NAPBC-accredited and 111,547 patients (48%) were treated at NAPBC centers. More than 80% of patients treated at both NAPBC and non-NAPBC centers received care in compliance with breast quality measures. NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level and on five of six measures at the facility level. For two measures, needle/core biopsy before surgical treatment of breast cancer and breast conservation therapy rate of 50%, NAPBC centers were twice as likely as non-NAPBC centers to perform at the level expected by the CoC (respectively odds ratio [OR] 1.96, 95% confidence interval [CI] 1.85-2.08, p < 0.0001; and OR 2.05, 95% CI 1.94-2.15, p < 0.0001). CONCLUSIONS: While NAPBC accreditation at CoC centers is associated with higher performance on breast quality measures, the majority of patients at all centers receive guideline-concordant care. Future studies will determine whether higher performance translates into improved oncologic and patient-reported outcomes.
PURPOSE: This study was designed to determine whether accreditation by the National Accreditation Program for Breast Centers (NAPBC) is associated with improved performance on six breast quality measures pertaining to adjuvant treatment, needle/core biopsy, and breast conservation therapy rates at Commission on Cancer (CoC) centers. METHODS: National Cancer Database 2015 data were retrospectively reviewed to compare patients treated at CoC centers with and without NAPBC accreditation for compliance on six breast cancer quality measures. Mixed effects modeling determined performance on the quality measures adjusting for patient, tumor, and facility factors. RESULTS: Of 1308 CoC facilities, 484 (37%) were NAPBC-accredited and 111,547 patients (48%) were treated at NAPBC centers. More than 80% of patients treated at both NAPBC and non-NAPBC centers received care in compliance with breast quality measures. NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level and on five of six measures at the facility level. For two measures, needle/core biopsy before surgical treatment of breast cancer and breast conservation therapy rate of 50%, NAPBC centers were twice as likely as non-NAPBC centers to perform at the level expected by the CoC (respectively odds ratio [OR] 1.96, 95% confidence interval [CI] 1.85-2.08, p < 0.0001; and OR 2.05, 95% CI 1.94-2.15, p < 0.0001). CONCLUSIONS: While NAPBC accreditation at CoC centers is associated with higher performance on breast quality measures, the majority of patients at all centers receive guideline-concordant care. Future studies will determine whether higher performance translates into improved oncologic and patient-reported outcomes.
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