• Christine Laronga, Jhanelle E Gray, Erin M Siegel, Ji-Hyun Lee, William J Fulp, Michelle Fletcher, Fred Schreiber, Richard Brown, Richard Levine, Thomas Cartwright, Guillermo Abesada-Terk, George Kim, Carlos Alemany, Douglas Faig, Phillip Sharp, Merry-Jennifer Markham, David Shibata, Mokenge Malafa, and Paul B Jacobsen.
• Department of Women's Oncology, Tampa, FL. Electronic address: christine.laronga@moffitt.org.
• J. Am. Coll. Surg. 2014 Oct 1; 219 (4): 638-45.e1.

BackgroundThe Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts.Study DesignQuality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation.ResultsCharts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035).ConclusionsThe 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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