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 http://www.ihi.org/Topics/QualityCostValue/Pages 1. /Resources.asp quality measures. Agency for Health Quality and x Accessed June 30, 2015. Health and Medicine Division. Delivering High - 10. Research. http://www.qualitymeasures.ahrq.gov/search/searc 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. http://www.nationalacademies.org/hmd/Reports/2 quality measures. Agency for Health Quality and - -Care -Cancer -Quality -High ring 013/Delive Research. Charting -a-New -Course -for -a-System -in- http://www.qualitymeasures.ahrq.gov/tutorial/inde 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 http://www.iom.edu/Reports/2013/Delivering - Resear ch. -Cancer - -Charting -a-New http://www.qualitymeasures.ahrq.gov/tutorial/usin 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. - http://www.instituteforquality.org/practice ttri http://www.qualitymeasures.ahrq.gov/tutorial/a 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 http://www.qualityforum.org/Measuring_Performa Accessed https://www.facs.org/quality 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 https://www.facs.org/quality http://www.qualityforum.org/QPS/QPSTool.aspx# 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. https://www.facs.org/quality -programs/napbc http://www.ahrq.gov/research/findings/nhqrdr/ind 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:// www.facs.org/quality Research and Quality. programs/cancer/coc/standards Accessed June 30, http://www.ahrq.gov/workingforquality/ 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.
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