Indicators based on registers and administrative data for breast cancer: routine evaluation of oncologic care pathway can be implemented.
OBJECTIVE
Assuring the best standards of care - in a sustainable way - in chronic diseases as breast cancer is nowadays an important challenge for any health system. The aim of this study was to present the methodology used to define a set of quality indicators, computable from administrative data for the pathway of care of breast cancer, and its application at a population level.


METHODS
The cohort of 2007-2009 incident cases of breast cancer was identified through a network of six cancer registers in Northern Italy. Cases of sarcoma and lymphoma, patients with multiple primary cancers and those metastatic at diagnosis were excluded; 9614 women were retained for the analysis. For each indicator, the sub-cohort of women eligible for the diagnostic/therapeutic procedures was identified and calculations were performed through record linkage between the cohort and sources of health information. Data on potential available confounders or prognostic factors were also collected.


RESULTS
For a few indicators, such as cyto-histological assessment before surgery (62%) and intensive follow-up (79%), deviation from recommendations was evident. Younger patients (≤50 years) more frequently needed a short term re-intervention, while older patients less frequently underwent reconstructive surgery and received palliative care. Several indicators had a great variability across hospitals. In some cases, this heterogeneity appeared to be related to the hospital size, with high-volume hospitals being more compliant to guidelines.


CONCLUSIONS
It is possible to evaluate the quality of cancer care delivered in clinical practice in recent years, in order to implement interventions aimed to improve adherence to international standards of care.
Osservatorio Epidemiologico, ASL Milano 1, Magenta, Italy.|Centro di Biostatistica per l'Epidemiologia Clinica, Dipartimento di Scienze della Salute, Università di Milano Bicocca, Monza, Italy.
Anita
A
Andreano
Servizio di Epidemiologia e Registri di Popolazione, ASL Cremona, Cremona, Italy.
Emanuela
E
Anghinoni
Ss Epidemiologia, ASL Milano, Milano, Italy.
Mariangela
M
Autelitano
Dipartimento PAC, ASL Milano 2, Melegnano, Italy.
Aldo
A
Bellini
Direzione Generale Salute, Regione Lombardia, Milano, Italy.
Maurizio
M
Bersani
Servizio di Epidemiologia e Registri di Popolazione, ASL Cremona, Cremona, Italy.
Sabrina
S
Bizzoco
U.O. Epidemiologia, ASL Monza e Brianza, Monza, Italy.
Luca
L
Cavalieri d'Oro
Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milano, Italy.
Adriano
A
Decarli
Analisi Statistiche e Progetti di Ricerca, ASL Cremona, Cremona, Italy.
Silvia
S
Lucchi
Servizio di Epidemiologia e Registri di Popolazione, ASL Cremona, Cremona, Italy.
Salvatore
S
Mannino
Dipartimento PAC, ASL Milano 2, Melegnano, Italy.
Emerico
E
Panciroli
Centro di Biostatistica per l'Epidemiologia Clinica, Dipartimento di Scienze della Salute, Università di Milano Bicocca, Monza, Italy.
Paola
P
Rebora
U.O. Epidemiologia, ASL Monza e Brianza, Monza, Italy.
Magda
M
Rognoni
Servizio Epidemiologico Aziendale, ASL Bergamo, Bergamo, Italy.
Giuseppe
G
Sampietro
Analisi Statistiche e Progetti di Ricerca, ASL Cremona, Cremona, Italy.
Marco
M
Villa
Direzione Generale Salute, Regione Lombardia, Milano, Italy.
Carlo
C
Zocchetti
Servizio Epidemiologico Aziendale, ASL Bergamo, Bergamo, Italy.
Alberto
A
Zucchi
Centro di Biostatistica per l'Epidemiologia Clinica, Dipartimento di Scienze della Salute, Università di Milano Bicocca, Monza, Italy.
Maria Grazia
MG
Valsecchi
Osservatorio Epidemiologico, ASL Milano 1, Magenta, Italy.
Antonio Giampiero
AG
Russo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D015331:Cohort Studies; D019091:Critical Pathways; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009859:Oncology Nursing; D019984:Quality Indicators, Health Care; D012042:Registries
access; and evaluation; breast neoplasms; clinical pathways; guideline adherence; health care; health care evaluation mechanisms; health care quality; quality indicators