FROM: Theodore O. Will, Chief Executive Officer
DATE: Oct 09, 2002
SUBJECT: HCQIP Project: Improvements In Breast Cancer Pathology Practices Among Medicare Patients Undergoing Unilateral Extended Simple Mastectomy In New York State
IPRO CONTACTS:
Pascal James Imperato, M.D., M.P.H.&T.M., extension 532
Enclosed please find a statewide report on "Improvements in Breast Cancer Pathology Practices Among Medicare Patients Undergoing Unilateral Extended Simple Mastectomy in New York State." This quality improvement project was initiated in response to concerns expressed about the completeness of information contained in pathology reports on unilateral extended simple mastectomy specimens.
During 2000, IPRO worked with the members of its Breast Cancer Pathology Advisory Group (BCPAG) to design a project to assess the quality of pathology reports on unilateral extended simple mastectomy specimens for the period January 1-December 31, 1999. The group suggested that the reports be examined for a number of quality indicators relevant to patient care. A retrospective chart review was conducted in 2000 of 555 Medicare patients who underwent the procedure during the calendar year 1999.
Performance on six of seventeen quality indicators was 93.5% or better. Of particular concern was the finding of performance levels of below 84% on eight quality indicators relevant to prognosis and adjuvant therapy.
A collaborative intervention was undertaken with clinical pathologists, directors of hospital pathology laboratories and local specialty societies. Each hospital that performed unilateral extended simple mastectomies during the baseline study period received its own data so that it could compare its performance to the statewide aggregate (baseline). These results were also shared with the New York Pathological Society and the New York Society of Pathologists.
Telephone conference calls were conducted with the directors of hospital pathology laboratories, clinical pathologists and surgeons who perform breast cancer surgery at hospitals where most procedures occurred. The purpose of these telephone conference calls was to discuss the baseline findings, to encourage the adoption of standardized protocols and guidelines, and to assist hospitals in developing quality improvement programs.
A post-intervention chart review was conducted of 297 Medicare patients who underwent unilateral extended simple mastectomy during the period December 2001-May 31, 2002. This review examined the eight quality indicators, performance for which was below 84.0% in the baseline.
Statistically significant improvement (p<.0001) occurred in all these indicators during the post-intervention period, ranging from 12.6% to 19.9%. These indicators and their percent of improvement over the baseline are as follows:
These dramatic improvements reflect a highly successful collaborative effort and the implementation by many hospitals of quality improvement plans. In light of this success and currently available protocols, we highly recommend that all hospitals develop quality improvement plans where indicated.
Should you have any questions concerning this memorandum, please feel free to contact Pascal James Imperato, M.D., M.P.H. & T.M. at (516) 326-7767, ext. 532