First Study of Its Kind Finds National Accreditation Program for Breast Centers Leads to Better Quality Care
April 20, 2019
UH Clinical Update - April 2019
Where is a breast cancer patient likely to receive the most evidence-based, guideline-compliant care? According to a new UH-authored study published in the Annals of Surgical Oncology, it’s at a breast center accredited by the Commission on Cancer (CoC), and also by the newer, breast cancer-specific National Accreditation Program for Breast Cancers (NAPBC). This is the first study to specifically address the question.
UH breast surgeon Megan E. Miller, MD, at UH Seidman Cancer Center and colleagues across the country reviewed 2015 data on breast cancer patients, treatments, and facilities from the National Cancer Database. They then looked at six quality measures shared by the CoC and NAPBC, such as performing a needle biopsy before surgical treatment of breast cancer or achieving a target rate of 50 percent for breast conservation surgery among patients with early-stage breast cancer. The last step was to compare compliance with these quality measures between CoC centers and those with the extra NAPBC accreditation.
Results show that NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level, and on five of the six measures at the facility level. For needle biopsy and rate of breast conservation surgery, NAPBC centers were twice as likely as non-NAPBC centers to meet the standard.
Importantly, however, the study also found that the majority of breast cancer patients at all centers were receiving guideline-concordant care.
“The good news is that more than 80 percent of patients are receiving guideline-concordant care, no matter where they are going for their care, as long as they are at an accredited center,” Dr. Miller says.
According to the study, 37 percent of CoC-facilities were also NAPBC-accredited in 2015, with 48 percent of breast cancer patients being treated there.
“This shows that patients are seeking out those specialized breast cancer centers, instead of just generalized cancer care,” Dr. Miller says.
At UH, all breast cancers are NAPBC-accredited. This includes facilities at UH Cleveland Medical Center, UH Ahuja Medical Center, UH St. John Medical Center, UH Minoff Health Center at Chagrin Highlands, UH Westlake Health Center and joint-venture Southwest General Medical Center.
“We recently had our NAPBC site visit, and we passed with flying colors,” Dr. Miller says.
What explains the differences seen in the study between NAPBC and non-NAPBC centers?
“We think at the NAPBC centers, there is more coordinated care because they have the resources to dedicate solely to breast cancer care, as opposed to CoC centers, which are caring for all patients with cancer,” Dr. Miller says. “Some of the quality measures speak to the multidisciplinary nature of care, and that may be provided better at NAPBC centers.”
As different quality measures for breast cancer emerge in the medical literature, Dr. Miller says, the group plans to revisit the project. Likely new measures may address radiation therapy after breast cancer surgery, specifically partial breast radiation or intraoperative radiation; newer surgical approaches to the axillary lymph nodes after chemotherapy; adjuvant vs. neoadjuvant therapy; and evidence-based use of molecular assays in making treatment decisions about chemotherapy.
Ultimately, the team would also like to link quality measures to improved patient outcomes.
”Our next step would be to look at recurrence data and survival data for patients who received care in compliance with the guidelines and those who didn’t,” Dr. Miller says.
For now, however, the implications of this study are enormous.
“This is the first study that has looked at breast quality measures, even though they’ve been in existence for more than 10 years,” she says. "Our aim was to drill down to find out which centers are performing well. We were pleasantly surprised by our outcomes. Most patients really are receiving good care. It’s just a matter of getting every center up to the same standard or appropriately referring to accredited breast centers when needed. The patient comes first. Guidelines matter. They were not created just so we can check a box, but to truly improve patient care.”