Academic journal article Journal of Healthcare Management

How to Improve Breast Cancer Care Measurement and Reporting: Suggestions from a Complex Urban Hospital

Academic journal article Journal of Healthcare Management

How to Improve Breast Cancer Care Measurement and Reporting: Suggestions from a Complex Urban Hospital

Article excerpt

EXECUTIVE SUMMARY

Increasing scrutiny of clinical data reporting by healthcare accrediting organizations is challenging hospitals to improve measurement and reporting, especially in the area of cancer care. We sought to explore barriers to breast cancer adjuvant treatment measurement and reporting to a hospital tumor registry (TR) and to identify opportunities to improve these processes.

We conducted 31 key informant interviews with administrators and clinicians associated with a large urban hospital that treats a high volume of breast cancer patients. In this setting, up to 40 percent of early-stage breast cancer cases are treated by community-based oncologists, but reporting to the hospital's TR has been problematic. We asked about barriers to treatment measurement and reporting and sought suggestions to improve these processes. We used deductive and inductive methods to analyze interview transcripts.

We found seven management barriers to adjuvant treatment measurement and reporting: process complexity, limited understanding of TR reporting, competing priorities, resource needs, communications issues, lack of supporting information technologies (IT), and mistrust of management. The four facilitators of measurement and reporting we noted were increasing awareness, improving communications and relationships, enhancing IT, and promoting the value of measurement and reporting. Four factors deemed critical to successful improvements were organizational commitment, leadership support, resources, and communication.

Organizations striving to improve cancer care quality must overcome key barriers, especially those involving gaps in understanding and communication. In practice, hospitals should make explicit efforts to educate physicians and administrators about the importance of treatment reporting and to improve communications between the hospital's TR and physicians to ensure that needed adjuvant therapies are appropriately delivered.

INTRODUCTION

For women with early-stage breast cancer, postsurgical adjuvant treatments, including local (radiation) and systemic (chemo- and hormonal) therapies, have been shown to improve both disease-free and overall survival (Clarke et al., 2006; EBCTCG, 2005; Howell et al., 2005). Radiotherapy (RT) following breast-conserving surgery reduces the risk of recurrence by two thirds (27 percent to 9 percent) (Clarke et al., 2006). Chemotherapy reduces mortality by 27 percent in women under 50 years of age and by 11 percent in women aged 50 to 69 years (EBCTCG, 2005). Similarly, hormonal therapy, such as tamoxifen and aromatase inhibitors (Howell et al., 2005), reduces mortality by 31 percent among women with hormone receptor-positive tumors (EBCTCC, 2005; Howell et al., 2005). Given these compelling findings, the National Institutes of Health issued early-stage breast cancer treatment guidelines by the mid-1980s (NIH Consensus Conference, 1985), and these adjuvant therapies are now considered standard. Yet despite evidence that these treatments are effective, ensuring that adjuvant therapies are provided is difficult, and the level of breast cancer care quality has been found to vary considerably from established guidelines (Bickell et al., 2006; Griggs et al., 2007; Hershman et al., 2005; Hewitt & Simone, 1999; Malin et al., 2006).

The American College of Surgeons' (ACS) Commission on Cancer, a consortium of professional organizations devoted to improving survival and quality of life for cancer patients by setting practice standards, educating its members about emerging research, and monitoring comprehensive care quality (ACS, 2012a), recently implemented a new reporting requirement for breast cancer adjuvant treatment. This requirement mandates reporting of primary postsurgical adjuvant breast cancer therapies, reflecting recognition that data on actual practice are the necessary building blocks for quality improvement efforts (ACS, 2012b). …

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