title: Selecting high priority quality measures for breast cancer quality improvement.
abstract: BACKGROUND
  Although many quality measures have been created, there is no consensus regarding which are the most important. We sought to develop a simple, explicit strategy for prioritizing breast cancer quality measures based on their potential to highlight areas where quality improvement efforts could most impact a population.
  
  
  METHODS
  Using performance data for 9019 breast cancer patients treated at 10 National Comprehensive Cancer Network institutions, we assessed concordance relative to 30 reliable, valid breast cancer process-based treatment measures. We identified 4 attributes that indicated there was room for improvement and characterized the extent of burden imposed by failing to follow each measure: number of nonconcordant patients, concordance across all institutions, highest concordance at any 1 institution, and magnitude of benefit associated with concordant care. For each measure, we used data from the concordance analyses to derive the first 3 attributes and surveyed expert breast cancer physicians to estimate the fourth. A simple algorithm incorporated these attributes and produced a final score for each measure; these scores were used to rank the measures.
  
  
  RESULTS
  We successfully prioritized quality measures using explicit, objective methods and actual performance data. The number of nonconcordant patients had the greatest influence on the rankings. The highest-ranking measures recommended chemotherapy and hormone therapy for hormone-receptor positive tumors and radiation therapy after breast-conserving surgery.
  
  
  CONCLUSIONS
  This simple, explicit approach is a significant departure from methods used previously, and effectively identifies breast cancer quality measures that have broad clinical relevance. Systematically prioritizing quality measures could increase the efficiency and efficacy of quality improvement efforts and substantially improve outcomes.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. mhassett@partners.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hughes
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ottesen
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bookman
authors.forename: Robert W
authors.initials: RW
authors.lastname: Carlson
authors.forename: Richard L
authors.initials: RL
authors.lastname: Theriault
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
mesh_terms: D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005260:Female; D006292:Health Priorities; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011788:Quality of Life