Breast cancer quality of care in Taiwan in relation to hospital volume: a population-based cohort study.
OBJECTIVE
To evaluate, compare and improve quality of care for patients with breast cancer at the institution and population level requires a standard set of core measures. We performed a population-based cohort study to examine the association between hospital volume and breast cancer core measures compliance in Taiwan.


METHODS
Data were obtained from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. All women with a diagnosis of breast cancer between 2007 and 2011 were selected. Hospitals were divided into quartiles of hospital volume based on the total number of breast cancer surgery performed from 2007 to 2011. The core measure set that evaluates the quality of care for breast cancer included one preoperation and nine treatment-related indicators.


RESULTS
Our final study population included 38 943 patients from 74 hospitals. An increase in hospital volume was associated with better core measures compliance as indicated by higher adherence rates. As compared with the lower quartiles (quartiles 1/2/3) of hospital volume, quartile 4 (high volume) showed significantly higher adherence rate in two indicators measured ("percentage of breast cancer patients whose diagnoses were histologically and cytologically confirmed before surgery" and "percentage of stage 1 and 2 patients with sentinel node sampling performed," P = 0.011 and 0.016, respectively). An increasing trend in compliance for "percentage of stage 1 patients who underwent breast conserving surgery" was observed in high-volume but not low-volume hospitals (P < 0.001).


CONCLUSIONS
This institution and population-based study showed a certain degree of variation to core measures compliance among hospitals. In some aspects of pre- and postoperative care, high-volume hospitals demonstrated higher and more improved quality as supported by increased adherence rates. Further research is needed to determine whether better core measures compliance would result in better outcomes.
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Fu
F
Ou-Yang
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Nicholas C
NC
Hsu
Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Chiung-Hui
CH
Juan
College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hsin-I
HI
Huang
College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Sin-Hua
SH
Moi
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
Fang-Ming
FM
Chen
National Health Research Institutes, Miaoli, Taiwan.
Tsang-Wu
TW
Liu
Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.|National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan.
Ming-Feng
MF
Hou
D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011787:Quality of Health Care; D012042:Registries; D013624:Taiwan / Q000453:epidemiology
breast cancer; core measure; hospital volume; medical center