Berger Elizabeth R, Wang Chihsiung E, Kaufman Cary S, Williamson Ted J, Ibarra Julio A, Pollitt Karen, Bleicher Richard J, Connolly James L, Winchester David P, Yao Katharine A
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL.
National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
J Am Coll Surg. 2017 Mar;224(3):236-244. doi: 10.1016/j.jamcollsurg.2016.11.006. Epub 2016 Dec 18.
The National Accreditation Program for Breast Centers (NAPBC) was established in 2008 by the American College of Surgeons as a quality-improvement program for patients with breast disease. An NAPBC quality measure states post-mastectomy patients with ≥4 positive lymph nodes should receive lymph node radiation therapy (PMRT). Our objective was to examine how NAPBC accreditation has affected compliance with this quality measure.
Women who underwent mastectomy at either an NAPBC-accredited center or a Commission on Cancer-only accredited hospital were identified (2006 to 2013) in the National Cancer Data Base. The NAPBC centers accredited from 2009 to 2011 were included in the analysis. Patients were nested within centers using a mixed effects model to identify PMRT rates at each center before and after accreditation, adjusting for patient and tumor characteristics.
Of 34,752 patients from 477 NAPBC-accredited centers and 958 Commission on Cancer-only accredited hospitals who underwent mastectomy with ≥4 positive lymph nodes, 21,638 patients received PMRT during the study period (62.3%). The NAPBC centers yielded a significantly higher rate of PMRT than Commission on Cancer hospitals (66.0% vs 59.2%; p < 0.001). For each year of accreditation (2009 to 2011), centers had significantly higher rates of radiation in the accreditation year compared with the year before accreditation (p < 0.001). Within those centers, the rate of radiation increased post-accreditation in each accreditation year (2009: 62.1% to 71.9%; 2010: 65.5% to 73.2%; 2011: 67.5% to 70.4%).
The NAPBC accreditation is associated with higher PMRT rates and better adherence to the PMRT quality measure. Future studies with more centers and longer follow-up are needed to determine whether this trend continues.
美国外科医师学会于2008年设立了国家乳腺中心认证计划（NAPBC），作为一项针对乳腺疾病患者的质量改进计划。NAPBC的一项质量指标规定，乳房切除术后有≥4个阳性淋巴结的患者应接受淋巴结放射治疗（PMRT）。我们的目的是研究NAPBC认证如何影响对这一质量指标的遵守情况。
在国家癌症数据库中识别出（2006年至2013年）在NAPBC认证中心或仅由癌症委员会认证的医院接受乳房切除术的女性。2009年至2011年认证的NAPBC中心纳入分析。使用混合效应模型将患者嵌套在中心内，以确定认证前后每个中心的PMRT率，并对患者和肿瘤特征进行调整。
在477个NAPBC认证中心和958个仅由癌症委员会认证的医院中，有34752例接受乳房切除术且有≥4个阳性淋巴结的患者，其中21638例患者在研究期间接受了PMRT（62.3%）。NAPBC中心的PMRT率显著高于癌症委员会认证的医院（66.0%对59.2%；p<0.001）。对于每年的认证（2009年至2011年），与认证前一年相比，中心在认证当年的放射治疗率显著更高（p<0.001）。在这些中心中，每个认证年份认证后放射治疗率均有所提高（2009年：62.1%至71.9%；2010年：65.5%至73.2%；2011年：67.5%至70.4%）。
NAPBC认证与更高的PMRT率以及对PMRT质量指标的更好遵守相关。需要更多中心参与且随访时间更长的未来研究来确定这一趋势是否会持续。
