title: Degree of variability in performance on breast cancer quality indicators: findings from the Florida initiative for quality cancer care.
abstract: OBJECTIVE
  The Florida Initiative for Quality Cancer Care (FIQCC) comprises 11 Florida practice sites that participate in comprehensive reviews of quality of care specific to patients with cancer. Here, we examined site adherence to performance indicators to assess quality of care for patients with breast cancer (BC).
  
  
  METHODS
  Quality indicators were scripted on the basis of accepted guidelines from the Quality Oncology Practice Initiative, National Comprehensive Cancer Network, American College of Surgeons, and site-specific expert panel consensus. Comprehensive chart reviews, including both medical and surgical oncology quality measures, were conducted for patients with BC first seen in 2006 by a medical oncologist at one of the sites. Statistical comparisons were made by the Pearson χ(2) exact test, using Monte Carlo estimation.
  
  
  RESULTS
  Charts of 622 patients were reviewed. Of the 34 indicators, seven for medical oncology and four for surgical oncology fell below the 85% level of adherence. A statistically significant difference (P < .001) in variation of performance across the sites was found for the following medical and surgical oncology indicators: documentation of menopausal status, family history, informed consent, planned chemotherapy regimen and flow sheet, American Joint Committee on Cancer staging, HER2/neu status, reporting of margin orientation and inking of the margins, histological grade, having a sentinel lymph node biopsy for invasive BC, and obtaining a mammogram within 14 months of definitive surgery.
  
  
  CONCLUSIONS
  The FIQCC has identified how multiple aspects of BC care can be improved. Findings are being used at the participating institutions to guide quality improvement efforts.
authors: H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa; Center for Cancer Care and Research/Watson Clinic, Lakeland; Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota; Space Coast Medical Associates, Titusville; Ocala Oncology Center, Ocala; Robert and Carol Weissman Cancer Center at Martin Memorial, Stuart; Mayo Clinic, Jacksonville; Florida Institute of Research, Medicine and Surgery, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; University of Florida/Shands Cancer Center, Gainesville, FL.
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