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J Surg Oncol. 2017 Mar;115(3):243-249. doi: 10.1002/jso.24516. Epub 2016 Nov 25.

Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit.

Author information

1
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
2
Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
3
Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
4
Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
5
Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
6
Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
7
Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
8
Department of Research, Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, The Netherlands.
9
Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
10
Department of Pathology, Laboratory for pathology Dordrecht e.o., Dordrecht, The Netherlands.
11
Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
12
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
13
Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
14
Department of Medical Oncology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands.
15
Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.

Abstract

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.

KEYWORDS:

benchmark; breast cancer; clinical audit; quality assurance; quality improvement; quality indicators

PMID:
27885679
DOI:
10.1002/jso.24516
[Indexed for MEDLINE]

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