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Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit
Author(s) -
van Bommel Annelotte C.M.,
Spronk Pauline E.R.,
Vrancken Peeters MarieJeanne T.F.D.,
Jager Agnes,
Lobbes Marc,
Maduro John H.,
Mureau Marc A.M.,
Schreuder Kay,
Smorenburg Carolien H.,
Verloop Janneke,
Westenend Pieter J.,
Wouters Michel W.J.M.,
Siesling Sabine,
Tjan Heijnen Vivianne C.G.,
van Dalen Thijs
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24516
Subject(s) - medicine , audit , breast cancer , mastectomy , guideline , cancer , breast conserving surgery , clinical audit , pathology , management , economics
Background In 2011, the NABON Breast Cancer Audit (NBCA) was instituted as a nation‐wide audit to address quality of breast cancer care and guideline adherence in the Netherlands. The development of the NBCA and the results of 4 years of auditing are described. Methods Clinical and pathological characteristics of patients diagnosed with invasive breast cancer or in situ carcinoma (DCIS) and information regarding diagnosis and treatment are collected in all hospitals (n = 92) in the Netherlands. Thirty‐two quality indicators measuring care structure, processes and outcomes were evaluated over time and compared between hospitals. Results The NBCA contains data of 56,927 patients (7,649 DCIS and 49,073 invasive cancers). Patients being discussed in pre‐ and post‐operative multidisciplinary team meetings improved (2011: 83% and 91%; 2014: 98% and 99%, respectively) over the years. Tumour margin positivity rates after breast‐conserving surgery for invasive cancer requiring re‐operation were consistently low (∼5%). Other indicators, for example, the use of an MRI‐scan prior to surgery or immediate breast reconstruction following mastectomy showed considerable hospital variation. Conclusions Results shown an overall high quality of breast cancer care in all hospitals in the Netherlands. For most quality indicators improvement was seen over time, while some indicators showed yet unexplained variation. J. Surg. Oncol. 2017;115:243–249 . © 2016 Wiley Periodicals, Inc.