Florida initiative for quality cancer care

Improvements in breast cancer quality indicators during a 3-year interval

Christine Laronga, Jhanelle E. Gray, Erin M. Siegel, Ji Hyun Lee, William J. Fulp, Michelle Fletcher, Fred Schreiber, Richard Brown, Richard Levine, Thomas Cartwright, Guillermo Abesada-Terk, George Kim, Carlos Alemany, Douglas Faig, Phillip Sharp, Merry Jennifer Markham, David Shibata, Mokenge Malafa, Paul B. Jacobsen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.

Study Design Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.

Results Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).

Conclusions The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.

Original languageEnglish (US)
Pages (from-to)638-645.e1
JournalJournal of the American College of Surgeons
Volume219
Issue number4
DOIs
StatePublished - Oct 1 2014

Fingerprint

Quality of Health Care
Breast Neoplasms
Neoplasms
Documentation
Medical Oncology
Quality Improvement
Drug Therapy
Sentinel Lymph Node Biopsy
Chi-Square Distribution
Medical Records
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Florida initiative for quality cancer care : Improvements in breast cancer quality indicators during a 3-year interval. / Laronga, Christine; Gray, Jhanelle E.; Siegel, Erin M.; Lee, Ji Hyun; Fulp, William J.; Fletcher, Michelle; Schreiber, Fred; Brown, Richard; Levine, Richard; Cartwright, Thomas; Abesada-Terk, Guillermo; Kim, George; Alemany, Carlos; Faig, Douglas; Sharp, Phillip; Markham, Merry Jennifer; Shibata, David; Malafa, Mokenge; Jacobsen, Paul B.

In: Journal of the American College of Surgeons, Vol. 219, No. 4, 01.10.2014, p. 638-645.e1.

Research output: Contribution to journalArticle

Laronga, C, Gray, JE, Siegel, EM, Lee, JH, Fulp, WJ, Fletcher, M, Schreiber, F, Brown, R, Levine, R, Cartwright, T, Abesada-Terk, G, Kim, G, Alemany, C, Faig, D, Sharp, P, Markham, MJ, Shibata, D, Malafa, M & Jacobsen, PB 2014, 'Florida initiative for quality cancer care: Improvements in breast cancer quality indicators during a 3-year interval', Journal of the American College of Surgeons, vol. 219, no. 4, pp. 638-645.e1. https://doi.org/10.1016/j.jamcollsurg.2014.03.063
Laronga, Christine ; Gray, Jhanelle E. ; Siegel, Erin M. ; Lee, Ji Hyun ; Fulp, William J. ; Fletcher, Michelle ; Schreiber, Fred ; Brown, Richard ; Levine, Richard ; Cartwright, Thomas ; Abesada-Terk, Guillermo ; Kim, George ; Alemany, Carlos ; Faig, Douglas ; Sharp, Phillip ; Markham, Merry Jennifer ; Shibata, David ; Malafa, Mokenge ; Jacobsen, Paul B. / Florida initiative for quality cancer care : Improvements in breast cancer quality indicators during a 3-year interval. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 4. pp. 638-645.e1.
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abstract = "Background The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.Study Design Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.Results Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).Conclusions The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.",
author = "Christine Laronga and Gray, {Jhanelle E.} and Siegel, {Erin M.} and Lee, {Ji Hyun} and Fulp, {William J.} and Michelle Fletcher and Fred Schreiber and Richard Brown and Richard Levine and Thomas Cartwright and Guillermo Abesada-Terk and George Kim and Carlos Alemany and Douglas Faig and Phillip Sharp and Markham, {Merry Jennifer} and David Shibata and Mokenge Malafa and Jacobsen, {Paul B.}",
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AU - Laronga, Christine

AU - Gray, Jhanelle E.

AU - Siegel, Erin M.

AU - Lee, Ji Hyun

AU - Fulp, William J.

AU - Fletcher, Michelle

AU - Schreiber, Fred

AU - Brown, Richard

AU - Levine, Richard

AU - Cartwright, Thomas

AU - Abesada-Terk, Guillermo

AU - Kim, George

AU - Alemany, Carlos

AU - Faig, Douglas

AU - Sharp, Phillip

AU - Markham, Merry Jennifer

AU - Shibata, David

AU - Malafa, Mokenge

AU - Jacobsen, Paul B.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.Study Design Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.Results Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).Conclusions The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.

AB - Background The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.Study Design Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.Results Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).Conclusions The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.

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