title: Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO) research database.
abstract: BACKGROUND
  Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data.
  
  
  METHODS
  We included 4524 women ≥18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN) health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont.
  
  
  RESULTS
  The CRN institutions pre-filled 30% (22 out of 72) of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years); 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma.
  
  
  CONCLUSIONS
  The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data in the United States. Assembling data from electronic administrative databases and manual chart review balanced efficiency with high-quality, unbiased data collection. Using the BRCASO database, we will evaluate surgical quality measures including mastectomy rates, positive margin rates, and partial mastectomy re-excision rates among a diverse, non-voluntary population of patients, providers, and facilities.
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA. bowles.e@ghc.org
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Aiello Bowles
authors.forename: Heather Spencer
authors.initials: HS
authors.lastname: Feigelson
authors.forename: Tom
authors.initials: T
authors.lastname: Barney
authors.forename: Katherine
authors.initials: K
authors.lastname: Broecker
authors.forename: Andrew
authors.initials: A
authors.lastname: Sterrett
authors.forename: Kimberly
authors.initials: K
authors.lastname: Bischoff
authors.forename: Jessica
authors.initials: J
authors.lastname: Engel
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Gundersen
authors.forename: Johanna
authors.initials: J
authors.lastname: Sheehey-Jones
authors.forename: Richard
authors.initials: R
authors.lastname: Single
authors.forename: Adedayo
authors.initials: A
authors.lastname: Onitilo
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
authors.forename: Laurence E
authors.initials: LE
authors.lastname: McCahill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006285:Health Planning / Q000379:methods; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D014481:United States; D055815:Young Adult