title: Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit.
abstract: BACKGROUND
  In 2011, the NABON Breast Cancer Audit (NBCA) was instituted as a nation-wide audit to address quality of breast cancer care and guideline adherence in the Netherlands. The development of the NBCA and the results of 4 years of auditing are described.
  
  
  METHODS
  Clinical and pathological characteristics of patients diagnosed with invasive breast cancer or in situ carcinoma (DCIS) and information regarding diagnosis and treatment are collected in all hospitals (n = 92) in the Netherlands. Thirty-two quality indicators measuring care structure, processes and outcomes were evaluated over time and compared between hospitals.
  
  
  RESULTS
  The NBCA contains data of 56,927 patients (7,649 DCIS and 49,073 invasive cancers). Patients being discussed in pre- and post-operative multidisciplinary team meetings improved (2011: 83% and 91%; 2014: 98% and 99%, respectively) over the years. Tumour margin positivity rates after breast-conserving surgery for invasive cancer requiring re-operation were consistently low (∼5%). Other indicators, for example, the use of an MRI-scan prior to surgery or immediate breast reconstruction following mastectomy showed considerable hospital variation.
  
  
  CONCLUSIONS
  Results shown an overall high quality of breast cancer care in all hospitals in the Netherlands. For most quality indicators improvement was seen over time, while some indicators showed yet unexplained variation. J. Surg. Oncol. 2017;115:243-249. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.|Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
authors.forename: Annelotte C M
authors.initials: AC
authors.lastname: van Bommel
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.|Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
authors.forename: Pauline E R
authors.initials: PE
authors.lastname: Spronk
authors.affiliation: Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Marie-Jeanne T F D
authors.initials: MT
authors.lastname: Vrancken Peeters
authors.affiliation: Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: Jager
authors.affiliation: Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Lobbes
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: John H
authors.initials: JH
authors.lastname: Maduro
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Marc A M
authors.initials: MA
authors.lastname: Mureau
authors.affiliation: Department of Research, Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, The Netherlands.
authors.forename: Kay
authors.initials: K
authors.lastname: Schreuder
authors.affiliation: Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Carolien H
authors.initials: CH
authors.lastname: Smorenburg
authors.affiliation: Department of Research, Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Verloop
authors.affiliation: Department of Pathology, Laboratory for pathology Dordrecht e.o., Dordrecht, The Netherlands.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Westenend
authors.affiliation: Dutch Institute for Clinical Auditing, Leiden, The Netherlands.|Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.|Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: Siesling
authors.affiliation: Department of Medical Oncology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands.
authors.forename: Vivianne C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.affiliation: Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: van Dalen
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000201:enzymology / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009426:Netherlands / Q000453:epidemiology; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D000071077:Surgical Oncology / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data
keywords: benchmark; breast cancer; clinical audit; quality assurance; quality improvement; quality indicators