title: Improving on national quality indicators of breast cancer care in a large public hospital as a means to decrease disparities for African American women.
abstract: BACKGROUND
  In April 2007, the National Quality Forum (NQF) endorsed the first nationally recognized hospital-based performance measures for stage I, II, and III breast cancer. The purpose of this study was to document compliance with the 3 NQF breast quality indicators during 2 time intervals in a metropolitan public hospital.
  
  
  METHODS
  Tumor registry and medical records were used to identify patient demographics and treatments before (2005-2006) and after (2008) implementations in 2007 as a result of the NQF audit. Program changes included: hiring a dedicated medical oncology nurse practitioner, requiring the radiation oncology case manager to attend weekly multidisciplinary conferences, educating Patient Navigators of the importance of multimodal care, and providing support groups for patients addressing importance of completion of all treatment options.
  
  
  RESULTS
  A total of 213 female patients were diagnosed with and treated for stage I, II, or III breast cancer in 2005-2006 and 2008. Of these, 189 (89%) were African American (AA) women. Also, 70 patients of 86 (81.3%) received radiation therapy, 60 of 77 (77.9%) received or were considered for adjuvant chemotherapy, and 124 of 144 (86.1%) for hormonal therapy according to NQF indicators. After 2007, patients receiving radiation therapy increased from 75.8 to 95.8%. Patients receiving or considered for adjuvant chemotherapy or hormonal therapy increased from 73.7 to 93.7% and from 84.1 to 90.0%, respectively.
  
  
  CONCLUSIONS
  NQF breast cancer indicators provided a mechanism to improve compliance of multimodal treatment in our center. Raising awareness of these indicators in the multidisciplinary conference, hiring dedicated personnel, and educating patients has led to major improvements in breast cancer care.
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA, USA. mrizzo@emory.edu
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Harvey
authors.initials: H
authors.lastname: Bumpers
authors.forename: Joel
authors.initials: J
authors.lastname: Okoli
authors.forename: Diana
authors.initials: D
authors.lastname: Senior-Crosby
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Regan
authors.forename: Amelia
authors.initials: A
authors.lastname: Zelnak
authors.forename: Lin
authors.initials: L
authors.lastname: Pan
authors.forename: Marina
authors.initials: M
authors.lastname: Mosunjac
authors.forename: Sharla Gayle
authors.initials: SG
authors.lastname: Patterson
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D002173:Cancer Care Facilities; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult