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Measuring the Quality of Breast Cancer Care in Women
Evidence Reports/Technology Assessments, No. 105
Investigators: Howard M Schachter, PhD, Vasil Mamaladze, MD, Gabriela Lewin, MD, Larry Paszat, MD, Shailendra Verma, MD, Cathy DeGrasse, MScN, Ian Graham, PhD, Melissa Brouwers, PhD, Margaret Sampson, MLIS, Andra Morrison, BSc, Li Zhang, BSc, Peter O'Blenis, MBA, and Chantelle Garrity, BA.
Structured Abstract
Context:
It has been suggested that, on average, the quality of health care received by Americans, including breast cancer care in women, is less than ideal. Quality measurement can identify gaps in such patterns of care.
Objectives:
The purpose of this systematic review of the scientific-medical literature was to survey the range of quality measures assessing the quality of breast cancer care in women, and to characterize specific parameters potentially affecting their suitability for wider use. Specific emphasis was placed on diagnosis, treatment (including supportive care), followup, and documentation of this care. Screening and prevention fell outside the review scope. Quality measures quantify adherence to standards of care, or quality indicators (e.g., percentage of women receiving radiotherapy after breast-conserving surgery), and can vary in terms of the extent of their scientific development.
Data Sources:
A comprehensive literature search was conducted in: Medline, Cancerlit, Healthstar, Premedline, Embase, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, and Health and Psychosocial Instruments. Search elements included: diagnosis and treatment of breast cancer; quality measures; systematic reviews; clinical practice guidelines; and, commentaries or editorials. Additional published and unpublished literature was sought through manual searches of reference lists of included studies and key review articles, web sites, and from the files of content experts. ASCO was asked to contribute quality measures currently under development.
Study Selection:
Studies met eligibility criteria if they described evidence-based quality measures evaluating adherence to standards of breast cancer care. The population of interest was female adults diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast, including both in situ and invasive cancer. Three levels of screening, with two reviewers at each level, were employed. Disagreements between reviewers were resolved by forced consensus and, if necessary, third party intervention.
Data Extraction:
Three reviewers independently abstracted data (i.e., characteristics of the report, study, population, quality indicators used in quality measurement [e.g., validational history, data sources used], and adherence rate [e.g., overall, by age and race]), and then checked each other's work. A scheme was developed, then applied independently by two assessors, to examine the extent, and soundness, of the scientific development of each quality measure.
Data Synthesis:
Sixty relevant reports identified 58 studies and 143 quality indicators used to measure the quality of breast cancer care. Measures reflecting processes of care were the most frequently evaluated. Not all predefined types of care were assessed using quality measures. Only a qualitative synthesis was undertaken, given the virtual lack of scientifically developed quality measures (n = 12). Most of these assessed patient-reported quality of life.
Conclusions:
While some studies revealed patterns of underuse of care, these and all other adherence data require confirmation using scientifically validated quality measures. Current attempts by ASCO to formally develop a set of quality measures relating to breast cancer care may hold the key to conducting these definitive studies.
Contents
- Preface
- Acknowledgments
- 1. Introduction
- 2. Methods
- 3. Results
- 4. Discussion
- Summary Tables
- Figure
- References and Included Studies
- Listing of Studies Excluded at Level 2
- Appendices
- Appendix A. Search Strategies
- Appendix B. Letter to Society Representative
- Appendix C. Data Assessment and Data Abstraction Forms
- Appendix D. Modified QUOROM Flow Chart
- Appendix E. Evidence Tables
- Appendix F. Listing of Studies Included in Evidence Tables
- Appendix G. Listing of Quality Indicators
- Appendix H. Listing of Reference Standards
- Appendix I. Additional Acknowledgments
Co-director: David Moher, MSc, Howard M Schachter, PhD
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0021. Prepared by: University of Ottawa Evidence-based Practice Center at the University of Ottawa, Ottawa, Canada.
Suggested citation:
Schachter HM, Mamaladze V, Lewin G, Paszat L, Verma S, DeGrasse C, Graham I, Brouwers M, Sampson M, Morrison A, Zhang L, O'Blenis P, Garrity C. Measuring the Quality of Breast Cancer Care in Women. Evidence Report/Technology Assessment No. 105. (Prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02-0021.) AHRQ Publication No. 04-E030-2. Rockville, MD: Agency for Healthcare Research and Quality. October 2004.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
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- Measuring the Quality of Breast Cancer Care in WomenMeasuring the Quality of Breast Cancer Care in Women
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