title: Quality improvement by implementing an integrated oncological care pathway for breast cancer patients.
abstract: OBJECTIVE
  In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer pathway in three hospitals has improved the care for breast cancer patients.
  
  
  METHODS
  Retrospectively almost 800 patients with breast cancer were selected from the Netherlands Cancer Registry (NCR). The patients were divided in two groups: before implementation of the pathway in 2006-07 (baseline measurement) and those after implementation in 2009 (post measurement). Fourteen quality indicators were compared before and after the implementation of the care pathway. To estimate the impact of the care pathway relative to evidence based guidelines and profession-based norms, involved project leaders were interviewed.
  
  
  RESULTS
  Seven out of eight indicators with medical information and four out of five indicators with information about waiting- and throughput times improved. With the multidisciplinary meeting as key in the breast cancer care, more compliance to national guidelines was observed. E.g. for more patients a HER2neu test was performed after implementation of the pathway (from 92% to 96%, ⤳ = 0.016) and more patients started with their first chemotherapy (from 33% to 45%) or their first radiotherapy (from 55% to 59%) within 4 weeks after surgery.
  
  
  CONCLUSIONS
  Implementing a multidisciplinary breast cancer pathway leads to better compliance with the national guidelines and can improve breast cancer care.
authors.affiliation: Comprehensive Cancer Centre, The Netherlands. Electronic address: j.vanhoeve@iknl.nl.
authors.forename: J
authors.initials: J
authors.lastname: van Hoeve
authors.affiliation: Comprehensive Cancer Centre, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: de Munck
authors.affiliation: Comprehensive Cancer Centre, The Netherlands; University Medical Centre Groningen, Medical Oncology, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Otter
authors.affiliation: Department of Operations Management, Faculty of Economics and Business, University of Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Comprehensive Cancer Centre, The Netherlands; Health Technology and Services Research, University of Twente, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Siesling
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D019091:Critical Pathways / Q000592:standards*; D003695:Delivery of Health Care; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: Breast cancer; Care pathways; Integrated healthcare systems; Multidisciplinary cancer care