title: Florida Initiative for Quality Cancer Care: improvements in breast cancer quality indicators during a 3-year interval.
abstract: BACKGROUND
  The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.
  
  
  METHODS
  Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.
  
  
  RESULTS
  Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).
  
  
  CONCLUSIONS
  The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.
authors.affiliation: Department of Women's Oncology, Tampa, FL. Electronic address: christine.laronga@moffitt.org.
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.affiliation: Department of Thoracic Oncology, Tampa, FL.
authors.forename: Jhanelle E
authors.initials: JE
authors.lastname: Gray
authors.affiliation: Department of Cancer Epidemiology, Tampa, FL.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Siegel
authors.affiliation: Department of Biostatistics, Tampa, FL.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Tampa, FL.
authors.forename: William J
authors.initials: WJ
authors.lastname: Fulp
authors.affiliation: Department of Health Outcomes and Behavior, Tampa, FL.
authors.forename: Michelle
authors.initials: M
authors.lastname: Fletcher
authors.affiliation: Center for Cancer Care & Research/Watson Clinic, Lakeland, FL.
authors.forename: Fred
authors.initials: F
authors.lastname: Schreiber
authors.affiliation: Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL.
authors.forename: Richard
authors.initials: R
authors.lastname: Brown
authors.affiliation: Space Coast Medical Associates, Titusville, FL.
authors.forename: Richard
authors.initials: R
authors.lastname: Levine
authors.affiliation: Florida Cancer Affiliates, Ocala, FL.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cartwright
authors.affiliation: Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart, FL.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Abesada-Terk
authors.affiliation: Mayo Clinic, Jacksonville, FL.
authors.forename: George
authors.initials: G
authors.lastname: Kim
authors.affiliation: Florida Institute of Research, Medicine & Surgery, Orlando, FL.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alemany
authors.affiliation: North Broward Medical Center, Deerfield Beach, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Faig
authors.affiliation: Tallahassee Memorial Healthcare, Tallahassee, FL.
authors.forename: Phillip
authors.initials: P
authors.lastname: Sharp
authors.affiliation: University of Florida/Shands Cancer Center, Gainesville, FL.
authors.forename: Merry-Jennifer
authors.initials: MJ
authors.lastname: Markham
authors.affiliation: Department of Gastrointestinal Oncology, Tampa, FL.
authors.forename: David
authors.initials: D
authors.lastname: Shibata
authors.affiliation: Department of Gastrointestinal Oncology, Tampa, FL.
authors.forename: Mokenge
authors.initials: M
authors.lastname: Malafa
authors.affiliation: Department of Health Outcomes and Behavior, Tampa, FL.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D002173:Cancer Care Facilities / Q000592:standards*; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
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