title: Evaluating population-based breast cancer surgical practice in real time with a web-based synoptic operative reporting system.
abstract: BACKGROUND
  A Web-based synoptic operative reporting system (WebSMR) incorporates implicit guidelines and real-time feedback of a surgeon's practice compared with provincial data. This study compares rates of total mastectomy (TM) between the overall provincial and WebSMR patients and examines decision-making factors in WebSMR patients.
  
  
  METHODS
  Patients treated for invasive breast cancer (2007 to 2011) were identified from WebSMR and the Alberta Cancer Registry. Reports include surgery type and reasons for TM.
  
  
  RESULTS
  Among 5,787 patients in WebSMR (2007 to 2011), TM rate decreased from 48% to 42% (P < .001). In 2011, the provincial cancer registry recorded a 56% TM rate compared to 42% in WebSMR patients. Patient preference accounted for 36% in the latter group.
  
  
  CONCLUSIONS
  In WebSMR patients, TM rates were lower than the overall provincial rate and decreased significantly during the study period. Reasons are unclear, but guidelines and real-time feedback likely plays a role.
authors.affiliation: Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada.
authors.forename: Walley J
authors.initials: WJ
authors.lastname: Temple
authors.affiliation: Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Chin-Lenn
authors.affiliation: Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. Electronic address: lloyd.mack@albertahealthservices.ca.
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mack
mesh_terms: D000416:Alberta; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D020407:Internet; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data / Q000639:trends; D015413:Mastectomy, Simple / Q000706:statistics & numerical data* / Q000639:trends; D016347:Medical Records Systems, Computerized; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012042:Registries
keywords: Breast cancer; Population-based; Web-based synoptic operative reporting