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

• Published in: Journal of surgical oncology 2017-03, Vol.115 (3), p.243-249
• Main Authors: van Bommel, Annelotte C.M., Spronk, Pauline E.R., Vrancken Peeters, Marie‐Jeanne 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
• Format: Article
• Language: English
• Subjects: Aged; benchmark; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast Neoplasms, Male - enzymology; Breast Neoplasms, Male - pathology; Breast Neoplasms, Male - surgery; Cancer surgery; Carcinoma in Situ - epidemiology; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; clinical audit; Evidence-Based Practice; Female; Humans; Male; Mastectomy; Medical Audit - methods; Middle Aged; Neoplasm Invasiveness; Netherlands - epidemiology; Quality; quality assurance; Quality control; Quality Improvement; quality indicators; Quality Indicators, Health Care; Surgical Oncology - methods; Surgical Oncology - standards; Surgical Oncology - statistics & numerical data
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24516

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.