Clinical Auditing as an Instrument for Quality Improvement in Breast Cancer Care in the Netherlands: The National NABON Breast Cancer Audit

Annelotte C. M. Van Bommel*, Pauline E. R. Spronk, Marie-Jeanne T. F. D. Vrancken Peeters, Agnes Jager, Marc Lobbes, John H. Maduro, Marc A. M. Mureau, Kay Schreuder, Carolien H. Smorenburg, Janneke Verloop, Pieter J. Westenend, Michel W. J. M. Wouters, Sabine Siesling, Vivianne C. G. Tjan-Heijnen, Thijs Van Dalen, Nabon Breast Canc Audit

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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 (similar to 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. (C) 2016 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)243-249
Number of pages7
JournalJournal of Surgical Oncology
Volume115
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Keywords

  • breast cancer
  • clinical audit
  • quality assurance
  • quality improvement
  • quality indicators
  • benchmark
  • OF-CARE
  • INDICATORS

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