Department of General Surgery, Gundersen Lutheran Health System, Norma J. Vinger Center for Breast Care, 1900 South Avenue, La Crosse, WI 54601, USA.
Breast J. 2010 Sep-Oct;16(5):472-80. doi: 10.1111/j.1524-4741.2010.00970.x. Epub 2010 Aug 16.
Measurement of quality indicators and peer comparison has been demonstrated to improve quality of care. The goal of this study was to determine whether a community breast center, in collaboration with the National Consortium of Breast Centers (NCBC), could voluntarily audit the quality of breast cancer care, confidentially transmit quality information to the NCBC, and receive peer performance comparisons. Quality indicator metrics from consecutive breast cancer patients undergoing care at a community interdisciplinary breast center were entered into a prospective database of quality measures that were defined by the NCBC. Retrospective review of patients from 2004 to 2006 was performed and subsequent quality indicator data was submitted electronically to the NCBC National Quality Measures for Breast Centers (NQMBC(TM) ) program. The percentage of new cancer diagnoses made by needle biopsy techniques was 94%, 95% and 96% from 2004 to 2006. Sentinel lymph node utilization in eligible patients was 93%, 96% and 91% from 2004 to 2006 and the immediate intraoperative pathologic frozen section false negative rate of the sentinel lymph node was 6.5%, 4.7% and 4%. Chart documentation of "patient participation in shared decision making for breast conserving therapy versus mastectomy" improved from 74% to 99% (p<0.05) from 2004 to 2006. Adjuvant systemic treatment for stage 2 breast cancer occurred in 76%, 89% and 77% of patients from 2004 to 2006. Neutropenia requiring hospital admission occurred in no patients in 2004 but in 4.8% and 2.9% in 2005 and 2006. The re-excision lumpectomy rates for stage 0, 1, 2, and 3 breast cancer patients from 2004 to 2006 was 14.2%, 22% and 24.8%. Quality indicator data was submitted to the NQMBC(TM) with successful confidential receipt of peer performance comparisons. Voluntary interdisciplinary institutional audits of breast cancer quality can be successfully submitted to the NQMBC(TM) with confidential peer performance comparison.
测量质量指标并进行同行比较已被证明可以提高医疗质量。本研究的目的是确定社区乳房中心是否可以与全国乳房中心联合会（NCBC）合作，自愿审核乳腺癌护理质量，将质量信息机密地传输给 NCBC，并接收同行绩效比较。将连续接受社区跨学科乳房中心护理的乳腺癌患者的质量指标数据输入由 NCBC 定义的质量指标前瞻性数据库中。对 2004 年至 2006 年的患者进行回顾性审查，并随后将质量指标数据以电子方式提交给 NCBC 国家乳房中心质量指标（NQMBC（TM））计划。2004 年至 2006 年，通过针吸技术诊断的新癌症诊断百分比分别为 94%、95%和 96%。在符合条件的患者中，前哨淋巴结的利用率分别为 2004 年至 2006 年的 93%、96%和 91%，前哨淋巴结的即时术中病理冷冻切片假阴性率分别为 6.5%、4.7%和 4%。“患者参与保乳治疗与乳房切除术的共同决策”的图表记录从 2004 年的 74%提高到 2006 年的 99%（p<0.05）。2004 年至 2006 年，2 期乳腺癌患者接受辅助全身治疗的比例分别为 76%、89%和 77%。2004 年无患者因中性粒细胞减少症需住院治疗，但 2005 年和 2006 年分别有 4.8%和 2.9%的患者出现这种情况。2004 年至 2006 年，0、1、2 和 3 期乳腺癌患者的再切除术率分别为 14.2%、22%和 24.8%。质量指标数据已成功提交给 NQMBC（TM），并成功收到同行绩效比较的机密接收。自愿进行跨学科机构乳房癌质量审核，可以成功提交给 NQMBC（TM），并可机密接收同行绩效比较。
