title: Measuring standards of care for early breast cancer in an insured population.
abstract: OBJECTIVE
  To demonstrate the use of a combined data base to evaluate the care for local/regional invasive breast cancer in a large insured population of women aged less than 64 years.
  
  
  METHODS
  We linked the procedural and hospital claims from Blue Cross Blue Shield (BCBS) of Virginia with clinical stage data from the Virginia Cancer Registry (VCR) from 1989 to 1991. A total of 918 women were assessed with a median age of 50 years; 68% had tumors less than 2 cm, 30% had positive axillary nodes, and 68% were assessed as having local summary stage. A quality-of-care "report card" was used based on standards of care from international Consensus Conferences.
  
  
  RESULTS
  Eight percent had a mastectomy as the initial biopsy procedure. Sixty-nine percent of women ultimately underwent mastectomy. Of those women who underwent lumpectomy, 86% had subsequent radiation. Within 3 months of diagnosis, 43% had a bone scan and 20% a computed tomography (CT) scan. Of women with positive axillary lymph nodes, 83% aged less than 51 years and 52% aged 51 to 64 years received chemotherapy. Fifty-six percent of all women had claims from a medical oncologist. Of women having a total mastectomy, 27% had claims from a plastic surgeon. Sixty-six percent to 76% of women had a mammogram, 24% a bone scan, and 14% a CT scan in the 0-18 and 18-36 month intervals following primary treatment.
  
  
  CONCLUSIONS
  This study confirms the feasibility of linking sources of data that provide complementary information needed to develop measurements regarding standards of quality and efficiency of oncologic care. This report should serve as an initial benchmark while we await reports from other populations to define the best practice.
authors.affiliation: Department of Internal Medicine, Medical College of Virginia, Richmond 23298, USA. hillner@gems.vcu.edu
authors.forename: B E
authors.initials: BE
authors.lastname: Hillner
authors.forename: M K
authors.initials: MK
authors.lastname: McDonald
authors.forename: L
authors.initials: L
authors.lastname: Penberthy
authors.forename: C E
authors.initials: CE
authors.lastname: Desch
authors.forename: T J
authors.initials: TJ
authors.lastname: Smith
authors.forename: P
authors.initials: P
authors.lastname: Maddux
authors.forename: W P
authors.initials: WP
authors.lastname: Glasheen
authors.forename: S M
authors.initials: SM
authors.lastname: Retchin
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012042:Registries; D014768:Virginia