The effect of EUSOMA certification on quality of breast cancer care.
OBJECTIVE
The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast units to establish minimum standards and ensure specialist multidisciplinary care. In the present study we assess the impact of EUSOMA certification for all breast units for which sufficient information was available before and after certification.


METHODS
For 22 EUSOMA certified breast units data of 30,444 patients could be extracted from the EUSOMA database on the evolution of QI's before and after certification.


RESULTS
On the average of all units, the minimum standard of care was achieved for 12/13 QI's before and after EUSOMA certification (not met for DCIS receiving just one operation). There was a significant improvement of 5 QI's after certification. The proportion of patients with invasive cancer undergoing an axillary clearance containing >9 lymph nodes (91.5% vs 89.4%, p 0.003) and patients with invasive cancer having just 1 operation (83.1% vs 80.4%, p < 0.001) dropped, but remained above the minimum standard. The targeted standard of breast care was reached for the same 4/13 QI's before and after EUSOMA certification.


CONCLUSIONS
Although the absolute effect of EUSOMA certification was modest it further increases standards of care and should be regarded as part of a process aiming for excellence. Dedicated units already provide a high level of care before certification, but continuous monitoring and audit remains of paramount importance as complete adherence to guidelines is difficult to achieve.
Breast Unit, Antwerp University Hospital, Edegem, Belgium. Electronic address: peter.vandam@telenet.be.
P A
PA
van Dam
AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA, Data Centre, Turin, Italy.
M
M
Tomatis
EUSOMA, Florence, Italy.
L
L
Marotti
Breast Unit, University of Heidelberg, Germany.
J
J
Heil
Royal Marsden Hospital, London, UK.
R
R
Wilson
EUSOMA, Florence, Italy.
M
M
Rosselli Del Turco
GIPMa, Comprensorio Sanitario di Bolzano, Italy.
C
C
Mayr
Centro Senologia Multimedica Castellanza, Italy.
A
A
Costa
Brustcentrum am Marienhospital Aachen, Germany.
M
M
Danei
Brustzentrum St. Joseph-Stift Bremen, Germany.
A
A
Denk
Universitaets Frauenklinik Gottingen, Germany.
G
G
Emons
Mammazentrum Hamburg, Germany.
K
K
Friedrichs
Breast Center, University of Munich (LMU), Munich, Germany.
N
N
Harbeck
Klinikum Rechts der Isar der Technischen Universitaets, Munich, Germany.
M
M
Kiechle
Breast Cancer Center "St. Georg", Leipzig, Germany.
U
U
Koheler
Brustzentrum, Kliniken Essen Mitte, Germany.
S
S
Kuemmel
University Medical Center and Luisenhospital Aachen, Germany.
N
N
Maass
BrustGesundheitZentrum Tirol, Innsbruck, Austria.
C
C
Marth
Breast Center Sint Augustinus, Wilrijk, Belgium.
A
A
Prové
West German Cancer Center, Breast Unit, University Clinic Essen, Germany.
R
R
Kimmig
Breast Center Zurich, Switzerland.
C
C
Rageth
Maugeri Foundation, Pavia, Italy.
L
L
Regolo
Breast Unit, HSK, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
L
L
Salehi
Brustzentrum Mittelland Kantonsspitäler Aarau/Olten, Switzerland.
D
D
Sarlos
Medical University of Vienna, Austria.
C
C
Singer
Breast Unit, University of Heidelberg, Germany.
C
C
Sohn
Borstkliniek Kortrijk AZ Groeninge, Belgium.
G
G
Staelens
Breast Unit Humanitas Cancer Center, Rozzano, Italy.
C
C
Tinterri
AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA, Data Centre, Turin, Italy.
A
A
Ponti
D019985:Benchmarking; D001943:Breast Neoplasms / Q000628:therapy*; D002173:Cancer Care Facilities / Q000592:standards*; D002277:Carcinoma / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000628:therapy*; D002568:Certification; D017024:Chemotherapy, Adjuvant / Q000592:standards; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant / Q000592:standards; D012189:Retrospective Studies; D012955:Societies, Medical; D059039:Standard of Care
Audit; Benchmarking; Breast cancer; Chemotherapy; EUSOMA; Quality control; Radiotherapy