title: National Accreditation Program for Breast Centers Demonstrates Improved Compliance with Post-Mastectomy Radiation Therapy Quality Measure.
abstract: BACKGROUND
  The National Accreditation Program for Breast Centers (NAPBC) was established in 2008 by the American College of Surgeons as a quality-improvement program for patients with breast disease. An NAPBC quality measure states post-mastectomy patients with ≥4 positive lymph nodes should receive lymph node radiation therapy (PMRT). Our objective was to examine how NAPBC accreditation has affected compliance with this quality measure.
  
  
  METHODS
  Women who underwent mastectomy at either an NAPBC-accredited center or a Commission on Cancer-only accredited hospital were identified (2006 to 2013) in the National Cancer Data Base. The NAPBC centers accredited from 2009 to 2011 were included in the analysis. Patients were nested within centers using a mixed effects model to identify PMRT rates at each center before and after accreditation, adjusting for patient and tumor characteristics.
  
  
  RESULTS
  Of 34,752 patients from 477 NAPBC-accredited centers and 958 Commission on Cancer-only accredited hospitals who underwent mastectomy with ≥4 positive lymph nodes, 21,638 patients received PMRT during the study period (62.3%). The NAPBC centers yielded a significantly higher rate of PMRT than Commission on Cancer hospitals (66.0% vs 59.2%; p < 0.001). For each year of accreditation (2009 to 2011), centers had significantly higher rates of radiation in the accreditation year compared with the year before accreditation (p < 0.001). Within those centers, the rate of radiation increased post-accreditation in each accreditation year (2009: 62.1% to 71.9%; 2010: 65.5% to 73.2%; 2011: 67.5% to 70.4%).
  
  
  CONCLUSIONS
  The NAPBC accreditation is associated with higher PMRT rates and better adherence to the PMRT quality measure. Future studies with more centers and longer follow-up are needed to determine whether this trend continues.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL. Electronic address: elizabethrberger@gmail.com.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Berger
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Chihsiung E
authors.initials: CE
authors.lastname: Wang
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Surgery, Bellingham Regional Breast Center, Bellingham, WA.
authors.forename: Cary S
authors.initials: CS
authors.lastname: Kaufman
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Radiation Oncology, Salem Hospital, Salem, OR.
authors.forename: Ted J
authors.initials: TJ
authors.lastname: Williamson
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Pathology, Orange Coast Memorial Medical Center, Fountain Valley, CA.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ibarra
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
authors.forename: Karen
authors.initials: K
authors.lastname: Pollitt
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: James L
authors.initials: JL
authors.lastname: Connolly
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Cancer Programs, American College of Surgeons, Chicago, IL.
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.affiliation: National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL; Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Yao
mesh_terms: D000068:Accreditation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D002173:Cancer Care Facilities; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011786:Quality Control; D014481:United States