title: Institutional review of compliance with NCCN guidelines for breast cancer: lessons learned from real-time multidimensional synoptic reporting.
abstract: BACKGROUND
  Variations exist in compliance with NCCN Guidelines. Prior reports of adherence to NCCN Guidelines contain limitations because of lack of contemporary review and incomplete listing of reasons for noncompliance.
  
  
  OBJECTIVE
  To assess institutional compliance and assist national quality improvement strategies through identifying valid reasons for noncompliance.
  
  
  METHODS
  Compliance with NCCN Guidelines was recorded prospectively using electronic synoptic templates for patients with newly diagnosed breast cancer treated at a single institution between January 2010 and December 2011. Compliance with NCCN Guidelines was recorded. The accuracy of real-time synoptic auditing methods compared with retrospective chart review and reasons for noncompliance was assessed. SAS 9.3 software was used for data analysis.
  
  
  RESULTS
  Compliance with NCCN Guidelines among 395 patients was 94% for initial staging evaluation, 97% for surgery, 91% for chemotherapy, 89% for hormone therapy, 91% for radiation therapy, 85% for follow-up, and 100% for determination of estrogen receptor/progesterone receptor and HER2 status. Age, comorbidities, and stage influenced guideline compliance. The most common reasons for noncompliance were patient refusal, patient choice after shared decision-making, and overuse of testing. Synoptic templated reporting was accurate in 97% patients.
  
  
  CONCLUSIONS
  High compliance with NCCN Guidelines was demonstrated. Reasons for noncompliance were identifiable. Compliance and nonadherence can be evaluated quickly with electronic synoptic reporting. This allows real-time action plans to address quality concerns and aids national risk adjustment for comparison and benchmarking.
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Titilayo O
authors.initials: TO
authors.lastname: Adegboyega
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Jared H
authors.initials: JH
authors.lastname: Linebarger
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Johnson
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Andersen
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Dietrich
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Collin D
authors.initials: CD
authors.lastname: Driscoll
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Meghana
authors.initials: M
authors.lastname: Raghavendra
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin. From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Anusha R
authors.initials: AR
authors.lastname: Madadi
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Hamadani
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Choua A
authors.initials: CA
authors.lastname: Vang
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Marcou
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Jane
authors.initials: J
authors.lastname: Hudak
authors.affiliation: From the Department of Surgery, Department of Medical Education, Norma J. Vinger Center for Breast Care, Department of Pathology, Department of Medical Oncology, Department of Radiation Oncology, Department of Research, Department of Clinical Data Services, and Department of Hematology, Gundersen Health System, La Crosse, Wisconsin.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Go
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic