Consensus Guideline on Breast Surgeon Quality Measurement


1 Official Statement - - Consensus Guideline on Breast Surgeon Quality Measurement Purpose To describe the principles of quality measurement and improvement endorsed by the (ASBrS) American Society of Breast Surgeons Associated ASBrS Guidelines or Quality Measures 1. This Consensus Guideline replaces the ASBrS Position Statement on Breast Surgery Quality Measurement and Initiatives approved February 15, 2012 2. ASBrS Endorsed Quality Measures Methods 1. Comprehensive, but not a complete systematic review of literature, for healthcare quality measurement 2. Comprehensive review of healthcare policy stakeholder recommendations for use of quality measures (QM) to identify quality gaps and aid quality improvement. 3. The ASBrS Patient Safety and Quality Committee developed a consensus document that was reviewed and approved by the ASBS Board of Directors. Summary of Data Reviewed 1. Quality measurement policy recommendations of the Institute of Medicine, th e National Quality Forum, the Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement, The American College of Surgeons, the Commission on Cancer, the Surgical Quality Alliance, the American Society of Clinical Oncologists, the American Medical Association PCPI, the National Consortium of Breast Centers, the National Accreditation Program for Breast Centers, and the European Union of Breast Cancer Specialists. 2. Review of the National Quality Strategy, the National Quality Health care and Disparities Reports, and the ASCO report on “The State of Cancer Care in America 2015” 3. Publications regarding surgical and breast cancer quality measurement

2 2 Recommendations the Breast surgeons should search for disparities, inequalities, and gaps in 1. quality of breast surgical care. Gaps are identified when there is proof of variability of performance synchronous with evidence that good performance is possible; i.e. actual care does not match achievable care. Breast specific “quality measures” (QM ) should be developed, then used for 2. quality gap identification, peer performance comparison, and quality improvement initiatives. QMs are an attempt to quantify quality of care in a specific -operative general surgical morbidity and mortality outcome QM domain of care. Post are important but not sufficient to measure breast surgical performance. 3. QMs should be developed for multiple domains of care to include, but not limited to care structure, process of care, outcomes, patient experience, care coordinati on, affordability, access, and population health. QMs require “specifications” 4. - a specific numerator, denominator, exception and exclusion criteria. These specifications improve fairness during peer comparisons because they differentiate between “quality ” and “non- quality” reasons why performance for a specific QM was “not met.” 5. New QMs should have “desirable attributes.” These include relevancy, importance (gap between desired and actual care), scientific soundness, and feasibility of measurement. performance comparison requires appropriate statistical risk adjustment 6. Peer for accuracy and fairness. Programs designed for breast -specific QM reporting and peer performance 7. comparison should be accessible for both general and breast specialty surgeons. Atte mpts should be made to develop programs that limit the surgeon burden of data entry. 8. Providers of care should not be expected to achieve 100% compliance with every QM. There are justifiable reasons why performance may not be achieved to include patient re -morbidities, and limited life expectancy. In addition, fusal, significant co performance for some QM can be dependent on multiple care providers and cannot be solely “attributed” to the surgeon. 9. The developers of QM and improvement initiatives should seek multi - stakeholder input to include patients, payers, and policymakers, in addition to the providers of care and their professional organizations. 10. Programs that intend to use breast cancer QM for “accountability” should not be developed without breast surge on stakeholder representation. Accountability use includes public transparency, linking provider performance to financial compensation

3 3 (or penalty), patient steerage (eligibility to see a patient), and licensing or credentialing activities. QM program dat 11. a should be reviewed periodically for effectiveness and The results will drive decisions to continue, modify, or retire contemporary relevancy. specific QM or the entire program. The stewards of quality measurement must anticipate and monitor for 12. ed outcomes because quality initiatives may cause unintended and unintend adverse consequences such as provider “risk aversion” to care for a patient or change their choice of procedure to meet a “performance requirement” of a QM. variability of surgical care exists, all surgeons 13. Since there is ample evidence that should participate in quality measurement and improvement activities at some level to determine their level of performance. - References - National Quality Measures Clearinghouse. Breast 1. /Resources.asp quality measures. Agency for Health Quality and x Accessed June 30, 2015. Health and Medicine Division. Delivering High - 10. Research. Quality Cancer Care: Charting a New Course for a h.aspx?term=breast System in Crisis. The National Academies of Accessed June 30, 2015. Sciences, Engineering, Medicine. National Quality Measures Clearinghouse. Tutorials on 2. quality measures. Agency for Health Quality and - -Care -Cancer -Quality -High ring 013/Delive Research. Charting -a-New -Course -for -a-System -in- Accessed June 30, 2015. Crisis.aspx Accessed June 30, 2015. x.aspx 3. American Society of Clinical Oncology Institute for National Quality Measures Clearinghouse. Uses of 11. Quality. quality measures. Agency for Health Quality and - Resear ch. -Cancer - -Charting -a-New High -Quality -Care -for Course - -in-Crisis/Report -a-System g.aspx Accessed June 30, 2015. Brief091013.aspx Accessed June 30, 2015. 4. National Quality Measures Clearinghouse. Desirable American Society of Clinical Oncology. Practice and 12. attributes of a quality measure. Agency for Health guidelines. Quality and Research. - ttri Accessed June 30, 2015. -resources improvement Accessed June 30, 2015. butes.aspx 13. American College of Surgeons. Quality programs. 5. Measuring Performance. National Quality Forum. -programs Accessed June 30, 2015. Accessed June nce/Measuring_Performance.aspx 30, 2015. American College of Surgeons. National Surgical 14. ® ® 6. (ACS NSQIP NQF endorsed Quality Measures. National Quality ). Quality Improvement Program Forum. -nsqip -programs/acs Accessed June 30, 2015. Accessed June 30, 2015. American College of Surgeons. National accreditation 15. National Healthcare Quality and Disparities Reports. 7. program for breast centers. Agency for Healthcare Research and Quality. -programs/napbc Accessed June 30, 2015. Accessed June 30, 2015. ex.html American College of Surgeons. Commission on Cancer 16. 8. National Qualit y Strategy. Agency for Healthcare - Program Standards. https:// Research and Quality. programs/cancer/coc/standards Accessed June 30, 2015. Accessed June 30, 2015. 17. Surgical Quality Alliance. Document on public Institute for Healthcare Improvement. Quality, cost 9. reporting of surgical quality measures. and value resources.

4 4 College of Surgeons' cancer program accreditation -alliance quality Accessed June 30, 2015. in influencing oncologic outcomes. J Surg Oncol . Ame rican Medical Association Physician Consortium 18. 2014;110(5):611- 615. for Performance Improvement. Quality measure Dimick JB, Greenberg CC. Understanding gaps in 34. - development. http://www.ama surgical quality: learning to count what cannot be -resources/physician - counted. . 2013;257(1):6- 7. Ann Surg - -improvement/pcpi -performance consortium Greenberg CC, Lipsitz SR, Neville B, et al. Receipt 35. of -measure measures/about appropriate surgical care for Medicare ed June 30, 2015. Access . Arch Surg beneficiaries with cancer. TM 2011;146(10):1128- 34. National Consortium of Breast Centers. NQMBC 19. 36. Frasier LL, Greenberg CC, Neuman HB. Leveraging program for quality measures and measurement. comparative effectiveness research to improve the -performance -you - quality of multidisciplinary care for breast cancer -measure/ Accessed June 30, 2015. should pa tients. 20. Cancer Treat Res . 2015; 164:15- 30. Europeans Society of Breast Cancer Specialists. 37. Winchester DP. The National Accreditation Program o address variability of breast cancer Methods t for Breast Centers: a multidisciplinary approach to care. Accessed June 30, improve the quality of care for patients with 2015. diseases of the breast. 411. Kohn LT, Corrigan J, Donaldson MS. Committee on Breast J 21. . 2008;14:409– D, Haffty BG, Kaufman CS, Moran MS, Goss 38. Quality of Health Care in America, Institute of Winchester DP. Quality measures, standards, and Medicine. To Err is Human. Washington, DC: The accreditation for breast centers in the United States ss, 1999. National Academy Pre Int J Radiat Oncol Biol Phys 4. Institute of Medicine Committee on Quality of Health 22. . 2010;76(1):1- Anderson BO, Carlson RW, Kaufman CS, Kiel KD. 39. Care in America. Crossing the Quality Chasm: A Ensuring optimal interdisciplinar y breast care in New Health System for the 21st Century. . 2009;15(6):569- Breast J 570. the United States. Washington, DC: The National Academy Press;2001. 40. Kaufman CS, Shockney L, Rabinowitz B, et al. 23. Donabedian A. Evaluating the quality of medical care. National Quality Measures for Breast Centers 1966. 729. (NQMBC): a robust quality tool: breast center Milbank Q . 2005;83:691– 24. Donabedian A. The definition of quality and . 2010;17(2):377- Ann Surg Oncol quality measures. approaches to its assessment. Vol 1. Explorations 385. Greenberg CC, Lipsitz SR, Hughes ME, et al. 41. in Quality Assessment and Monitoring. Ann Arbor, Institutional variation in the surgical treatment of MI: Health Administration Press;1980. breast cancer: a study of the NCCN. Ann Surg. 25. Hassett MJ, Hughes ME, Niland JC, et al. Selecting 345. 2011;254(2):339- high priority quality measures for breast cancer 770. Adegboyega TO, Landercasper J, Linebarger JH, et al. . 2008;46:762– Med Care quality improvement. 42. view of compliance with NCCN Institutional re 26. American Society of Clinical Oncology. The state of guidelines for breast cancer: lessons learned from cancer care in America, 2015: a report by the time multidimensional synoptic reporting. real- American Society of Clinical Oncology. J Oncol J . 2015;11(2):79- 113. 183. . 2015;13(2):177- Pract Natl Compr Canc Netw - 43. 27. Edge SB. Quality measurement in breast cancer. Efficace F, Fayers P, Pusic A, et al. Quality of patient J Surg . 2014;110(5):509- 517. cross cancer reported outcome reporting a Oncol 28. Kaufman CS, Landercasper J. Can we measure the randomized controlled trials according to the quality of breast surgical care? Ann Surg Oncol . CONSORT patient -reported outcome extension: A Cancer . 2011;18(11):3053- 3060. pooled analysis of 557 trials. 3342. 2015;121(18):3335- 29. Rose C, Stovall E, Ganz PA, Desch C , Hewitt M. Brucker SY, Schumacher C, Sohn C, et al. 44. Cancer Quality Alliance: Blueprint for a better Benchmarking the quality of breast cancer care in CA Cancer J Clin cancer care system. . -year a nationwide voluntary system: the first five 2008;58:266– 292. –2007) from Germany as a proof of results (2003 Whitacre E. The importance of measuring the 30. concept. 2009;16:1090– Ann Surg Oncol. BMC Cancer . 2008;8:358. 1091. measures. 31. Wilke LG, Ballman KV, McCall LM, et al. Adherence Chen F, Puig M, Yermilov I, et al. Using breast cancer 45. to the National Quality Forum (NQF) breast cancer quality indicators in a vulnerable population. Cancer. –3321. 2011;117:3311 measures within cancer clinical trials: a review 46. Dimick JB, Osborne NH, Hall BL, Ko CY, Birkmeyer Ann Surg Oncol . from ACOSOG Z0010. 2010;17:1989– 1994. JD. Risk adjustment for comparing hospital quality 32. J with surgery: how many variables are needed? Warner ET, Tamimi RM, Hughes ME, et al. Racial Am Coll Surg and ethnic differences in breast cancer survival: 508. . 2010;210:503– 47. El-Tamer M. Surgical options as quality of care mediating effect of tumor characteristics and indicators in breast cancer. sociodemographic and treatment factors. . J Clin J Surg Oncol 2261. . 2015;33(20):2254- 2009;99:393– Oncol 394. 33. El-Tamer MB, Ward BM, Schifftner T, Neumayer L, Knutson AC, McNamara EJ, McKellar DP, Kaufman 48. CS, Winchester DP. The role of the American Khuri S, Henderson W. Morbidity and mortality

5 5 following breast cancer surgery in women: in a VA medical center. J Palliat Med . 2011;14:573– national benchmarks for standards of care. 577. Ann Malin JL, Schneider EC, Epstein AM, Adams J, . 2007;245:665– 671. 56. Surg Emanuel EJ, Kahn KL. Results of the National 49. Neumayer L, Schifftner TL, Henderson WG, Khuri SF, Initiative for Ca ncer Care Quality: how can we El-Tamer M. Breast cancer surgery in Veterans improve the quality of cancer care in the United Affairs and selected university medical centers: States? 634. . 2006;24:626– J Clin Oncol J Am results of the patient safety in surgery study. Coll Surg 57. . 2007;204:1235– 1241. McCahill LE, Privette A, James T, et al. Quality E, et al. Greenberg CC, Lipsitz SR, Hughes M 50. measures for breast cancer surgery: Initial Institutional variation in the surgical treatment of ariation validation of feasibility and assessment of v Ann Surg breast cancer: A study of the NCCN. 462. . 2009;144:455– Arch Surg . among surgeons. 345. 2011;254:339– Moran MS, Goss D, Haffty BG, Kaufman CS, 58. Hall BL, Hamilton BH, Richards K, Bilimoria KY, 51. Winchester DP. Quality measures, standards and Cohen ME, Ko CY. Does surgical quality improve accreditation for breast centers in the United . 2010;76:1– 4. Int J Radiat Oncol Biol Phys s National in the American College of Surgeon States. Surgical Quality Improvement Program: an Punglia RS, Hugh 59. es ME, Edge SB, et al. Factors evaluation of all participating hospitals. . Ann Surg associated with guideline concordant use of 2009;250:363– 376. radiotherapy after mastectomy in the NCCN. Int J 1440. 52. . Breast J Kaufman CS. Breast care is a team sport. . 2008;72:1434– Radiat Oncol Biol Phys 2004:10:469– 472. Rothberg MB, Morsi E, Benjamin EM, Pekow PS, 60. 53. Kaufman CS. Validating quality breast care: three new Lindenauer PK. Choosing the best hospital: t he validation programs for 2007. Am J Surg Health Aff . limitations of public quality reporting. 1687. 2008;27:1680– (Millwood). 517. 2007;194:515– 54. 61. Malin JL, Diamant AL, Leake B, et al. Quality of care Veerbeek L, van der Geest L, Wouters M, et al. Enhancing the quality of care for patients with for breast cancer for uninsured women in breast cancer: Seven years of experience with a California under the breast and cervical cancer Eur J Surg Oncol . J Clin Oncol . Dutch aud iting system. prevention treatment act. 2010;28:3479– 3484. 718. 2011;37:714– JL, O’Neill SM, Asch SM, et al. Quality of Malin 55. supportive care for patients with advanced cancer ommittee and on This statement was developed by the Society’s Research C approved b April 25, 2016 , was y the Board of Directors. © 2018 The American Society of Breast Surgeons

Related documents