Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

Women's choices of hospital for breast cancer surgery in Italy: Quality and equity implications

This paper employs mixed logit regression to investigate the effects of providers characteristics on women's choice of hospital for breast surgery. Patient level data are used to model choices in Tuscany region, Italy. In particular, we focus on the effects of travel time and hospital quality indicators including quality standard (volumes of breast surgery), measurement of process (waiting times) and quality of surgical procedures. Variation in preferences related to individual characteristics such as age, education and travel distance from the hospital are also considered. Findings show that, on average, women prefer closer hospital with longer waiting times and higher quality (high volumes of interventions). We found preference heterogeneity associated to education: travel distance affects choice especially among less educated women (regardless of age), while among younger women (<65 years), less educated ones prefer shorter waiting times. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

Effect of modified radical mastectomy combined with latissimus dorsi musculocutaneous flap breast reconstruction on patients' psychology and quality of life

BACKGROUND

Breast carcinoma (BC) is a commonly seen malignancy in women. Although traditional radical mastectomy can improve the survival of patients, it can cause breast loss and chest wall deformities, which seriously affects the daily life of patients and causes anxiety and depression. The purpose of this research project is to investigate the effect of breast reconstruction with latissimus dorsi myocutaneous flap (LDMF) after nipple- and areola-sparing modified radical mastectomy (MRM) on the psychological mood and quality of life (QoL) of patients with stage I BC.

METHODS

A total of 102 patients with BC (research group, RG) treated in the Shanghai Fifth People's Hospital, Fudan University from January 2018 to December 2020 were selected for phase I breast reconstruction with LDMF after nipple- and areola-sparing MRM. Concurrently, 50 BC patients (control group, CG) who underwent traditional total mastectomy in our hospital were collected. The activities of daily living (ADL), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were observed before and 1 month after treatment. The intraoperative indicators, postoperative complications, postoperative satisfaction rate and overall survival rate were compared.

RESULTS

The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) score was higher after treatment, while SAS and SDS scores were lower in RG than in CG (P<0.05). No statistical difference was observed in intraoperative blood loss, wound drainage time, operation time, postoperative complications and overall survival rate between the two cohorts (P>0.05). RG showed higher satisfaction degree and overall satisfaction rate, as well as better QoL than CG (P<0.05).

CONCLUSIONS

Breast reconstruction with LDMF after nipple- and areola-sparing MRM can alleviate adverse emotions of patients with stage I BC and improve their QoL.

Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study

BACKGROUND

Variation in breast cancer surgical practice patterns can lead to poor clinical outcomes. It is important to measure and reduce variation to ensure all women diagnosed with breast cancer receive equitable, high-quality care. A population-based assessment of the variation in breast cancer surgery treatment and quality has never been conducted in Manitoba. The objective of this study was to assess the variation in surgical treatment patterns, quality of care, and post-operative outcomes for women diagnosed with invasive breast cancer.

METHODS

This descriptive study used data from the Manitoba Cancer Registry, Hospital Discharge Abstracts Database, Medical Claims, Manitoba Health Insurance Registry, and Statistics Canada. The study included women in Manitoba aged 20+ and diagnosed with invasive breast cancer between 1 January 2010 and 31 December 2014.

RESULTS

Axillary lymph node dissection (ALND) for node-negative disease ranged from 11.8% to 33.3%, timeliness (surgery within 30 days of consult) ranged from 33.3% to 60.2%, and re-excision ranged from 14.7% to 24.6% between health authorities. Women who underwent breast-conserving surgery had the shortest median length of stay and women who underwent mastectomy with immediate reconstruction had the longest median length of stay. In-hospital post-operative complications were higher among women who received mastectomy with immediate reconstruction (9.9%).

CONCLUSION

Variation in surgical treatment, quality, and outcomes exist in Manitoba. The findings from this study can be used to inform cancer service delivery planning, quality improvement efforts, and policy development. Influencing data-driven change at the health system level is paramount to ensuring Manitobans receive the highest quality of care.

Defining Quality Indicators for Breast Device Surgery: Using Registries for Global Benchmarking

Breast device registries monitor devices encompassing breast implants, tissue expanders and dermal matrices, and the quality of care and patient outcomes for breast device surgery. Defining a standard set of quality indicators and risk adjustment factors will enable consistency and adjustment for case-mix in benchmarking quality of care across breast implant registries. This study aimed to develop a set of quality indicators to enable assessment and reporting of quality of care for breast device surgery which can be applied globally.

Methods

A scoping literature review was undertaken, and potential quality indicators were identified. Consensus on the final list of quality indicators was obtained using a modified Delphi approach. This process involved a series of online surveys, and teleconferences over 6 months. The Delphi panel included participants from various countries and representation from surgical specialty groups including breast and general surgeons, plastic and reconstructive surgeons, cosmetic surgeons, a breast-care nurse, a consumer, a devices regulator (Therapeutic Goods Administration), and a biostatistician. A total of 12 candidate indicators were proposed: Intraoperative antibiotic wash, intraoperative antiseptic wash, preoperative antibiotics, nipple shields, surgical plane, volume of implant, funnels, immediate versus delayed reconstruction, time to revision, reoperation due to complications, patient satisfaction, and volume of activity.

Results

Three of the 12 proposed indicators were endorsed by the panel: preoperative intravenous antibiotics, reoperation due to complication, and patient reported outcome measures.

Conclusion

The 3 endorsed quality indicator measures will enable breast device registries to standardize benchmarking of care internationally for patients undergoing breast device surgery.