title: Improving Quality Metric Adherence to Minimally Invasive Breast Biopsy among Surgeons Within a Multihospital Health Care System.
abstract: BACKGROUND
  Minimally invasive breast biopsy (MIBB) is the procedure of choice for diagnosing breast lesions indeterminate for malignancy. Multihospital health care systems face challenges achieving systemwide adherence to standardized guidelines among surgeons with varying practice patterns. This study tested whether providing individual feedback about surgeons' use of MIBB to diagnose breast malignancies improved quality metric adherence across a large health care organization.
  
  
  METHODS
  We conducted a prospective matched-pairs study to test differences (or lack of agreement) between periods before and after intervention. All analytical cases of primary breast cancer diagnosed during 2011 (period 1) and from July 2012 to June 2013 (period 2) across a multihospital health care system were reviewed for initial diagnosis by MIBB or open surgical biopsy. Open surgical biopsy was considered appropriate care only if MIBB could not be performed for reasons listed in the American Society of Breast Surgeons' quality measure for preoperative diagnosis of breast cancer. Individual and systemwide results of adherence to the MIBB metric during period 1 were sent to each surgeon in June 2012 and were later compared with period 2 results using McNemar's test of marginal homogeneity for matched binary responses.
  
  
  RESULTS
  Forty-six surgeons were evaluated on use of MIBB to diagnose breast cancer. In period 1, metric adherence for 100% of cases was achieved by 37 surgeons, for a systemwide 100% compliance rate of 80.4%. After notification of individual performance, 44 of 46 surgeons used MIBB solely or otherwise appropriate care to diagnose breast cancer, which improved systemwide compliance to 95.7%.
  
  
  CONCLUSIONS
  Providing individual and systemwide performance results to surgeons can increase self-awareness of practice patterns when diagnosing breast cancer, leading to standardized best-practice care across a large health care organization.
authors.affiliation: Department of Surgical Oncology, Aurora Health Care, Milwaukee, WI. Electronic address: judy.tjoe@aurora.org.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Tjoe
authors.affiliation: Center for Population Urban Health, Aurora Health Care, Milwaukee, WI; Aurora University of Wisconsin Medical Group, Milwaukee, WI.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Greer
authors.affiliation: Care Management and Quality Improvement, Aurora Health Care, Milwaukee, WI.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Ihde
authors.affiliation: Care Management and Quality Improvement, Aurora Health Care, Milwaukee, WI.
authors.forename: Diane A
authors.initials: DA
authors.lastname: Bares
authors.affiliation: Department of Surgical Oncology, Aurora Health Care, Milwaukee, WI.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Mikkelson
authors.affiliation: Department of Surgical Oncology, Aurora Health Care, Milwaukee, WI.
authors.forename: James L
authors.initials: JL
authors.lastname: Weese
mesh_terms: D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D003142:Communication; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement