Fefferman Marie L, Thompson Danielle M, Wilke Lee G, Hwang Shelley, Bleicher Richard, Freedman Laura M, Meisel Jane L, Kuchta Kristine, Yao Katharine
Department of Surgery, Endeavor Health, Evanston, IL, USA.
Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Ann Surg Oncol. 2025 Mar;32(3):2045-2055. doi: 10.1245/s10434-024-16594-x. Epub 2024 Dec 10.
Since 2022, the Commission on Cancer (CoC) has developed three new breast cancer quality measures (QMs): time to surgery (BCSdx) and radiation (BCSRT) and the use of neoadjuvant therapy for triple negative and HER2/neu positive breast cancer (BneoCT). This study assesses CoC center historical performance for these measures and facility factors associated with low performance.
We examined the median number of days for time to surgery and radiation, and the proportion of facilities that achieved an estimated performance rate (EPR) of 70%, 80%, and 90% from 2004 to 2020 for all three measures. Multivariable logistic regression analysis was used to determine the association between facility factors and not achieving 80% EPR for all three measures.
The median number of days to surgery and radiation in 2004 were 16 and 43, respectively, compared with 34 and 48 in 2020 (p < 0.01). For BneoCT, BCSdx, and BCSRT measures, the proportion of facilities that attained ≥ 80% EPR was 68.5%, 72.2%, and 35.2%, respectively. The proportion of facilities that attained ≥ 80% EPR in 2004 was 92.3% for BCSdx and 49.8% for BCSRT compared with 69.6% and 39.4%, respectively, in 2020. BneoCT performance improved over time. Academic facilities and facilities serving a larger proportion of socioeconomically disadvantaged patients were approximately twice as likely to be unable to achieve compliance with all three QMs.
Performance levels for BCSRT are the lowest of all three measures. Academic centers and centers with a higher proportion of Medicaid patients are more likely to have lower adherence with all three QMs.
自2022年以来，癌症委员会（CoC）制定了三项新的乳腺癌质量指标（QMs）：手术时间（BCSdx）、放疗时间（BCSRT）以及三阴性和HER2/neu阳性乳腺癌新辅助治疗的使用情况（BneoCT）。本研究评估了CoC中心在这些指标上的历史表现以及与低表现相关的机构因素。
我们检查了手术和放疗时间的中位数天数，以及2004年至2020年期间所有三项指标达到估计表现率（EPR）70%、80%和90%的机构比例。采用多变量逻辑回归分析来确定机构因素与未达到所有三项指标80% EPR之间的关联。
2004年手术和放疗的中位数天数分别为16天和43天，而2020年分别为34天和48天（p < 0.01）。对于BneoCT、BCSdx和BCSRT指标，达到≥80% EPR的机构比例分别为68.5%、72.2%和35.2%。2004年达到≥80% EPR的机构比例，BCSdx为92.3%，BCSRT为49.8%，而2020年分别为69.6%和39.4%。BneoCT的表现随时间有所改善。学术机构以及服务社会经济弱势患者比例较高的机构无法达到所有三项QMs合规的可能性大约是其他机构的两倍。
BCSRT的表现水平在所有三项指标中最低。学术中心和医疗补助患者比例较高的中心更有可能在所有三项QMs上的依从性较低。
