Results of a Surgeon-Directed Quality Improvement Project on Breast Cancer Surgery Outcomes in South-Central Ontario
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Gaps in breast cancer (BC) surgical care have been identified. We have completed a surgeon-directed, iterative project to improve the quality of BC surgery in South-Central Ontario.
Surgeons performing BC surgery in a single Ontario health region were invited to participate. Interventions included: audit and feedback (A&F) of surgeon-selected quality indicators (QIs), workshops, and tailoring interviews. Workshops and A&F occurred yearly from 2005–2012. QIs included: preoperative imaging; preoperative core biopsy; positive margin rates; specimen orientation labeling; intraoperative specimen radiography of nonpalpable lesions; T1/T2 mastectomy rates; reoperation for positive margins; sentinel lymph node biopsy (SLNB) rates, number of sentinel lymph nodes; and days to receive pathology report. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All results were disseminated to all surgeons performing breast surgery in the study region.
Over 6 time periods, 1,828 BC charts were reviewed from 12 hospitals (8 community and 4 academic). Twenty-two to 40 participants attended each workshop. Sustained improvement in rates of positive margins, preoperative core biopsies, specimen orientation labeling, and SLNB were seen. Mastectomy rates and overall axillary staging rates did not change, whereas time to receive pathology report increased. The tailoring interviews concerning positive margins, SLNB, and reoperation for positive margins identified facilitators and barriers relevant to surgeons.
This surgeon-directed, regional project resulted in meaningful improvement in numerous QIs. There was consistent and sustained participation by surgeons, highlighting the importance of integrating the clinicians in a long-term, iterative quality improvement strategy in BC surgery.
KeywordsBreast Cancer Sentinel Lymph Node Biopsy Axillary Lymph Node Dissection Positive Margin Completion Axillary Lymph Node Dissection
Funding was provided by grants from the McMaster Surgical Associates and the Canadian Breast Cancer Foundation: Ontario Chapter. Initial planning workshops were supported by funding from the Juravinski Cancer Centre. Mary Ann O’Brien was supported by Postdoctoral Fellowships from the Canadian Breast Cancer Foundation and Psychosocial Oncology Research Training Program. The funding sources played no role in the design, conduct, or reporting of this study. The authors thank Dana Reeson, Michele Marcinow, Amanda Ramsaroop, Lianne Lindsay, Tiffaney Kittmer, and Dyda Dao for assistance with data collection and management. They also thank Ji Cheng for assistance with calculating process control charts.
All authors have no conflicts of interest to disclose.
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