Improving surgical performance for early stage breast cancer across multiple institutions

Lumpectomy (Breast Conserving Surgery - BCS) followed by radiation therapy provides survival benefit identical to that of mastectomy for early stage breast cancer. Yet BCS is still underutilized and its use varies significantly among hospitals. The purpose of the project was to decrease variation and increase the frequency of BCS across multiple Intermountain Health Care (IHC) facilities, and to sustain this improvement over time. The study methods involved 1) Identification of the outcome measure, data sources and required data elements; 2) Standardization of data collection processes across IHC facilities; 3) Collection and integration of required data elements from local cancer registries into a central database; 4) Development of performance profiling reports from the central database; 5) Implementation of feedback interventions to surgeons and evaluation of the frequency of BCS following these interventions. The results of the study revealed that before the implementation of feedback interventions (1998-2001), the average frequency of BCS was 53% at IHC facilities. After the implementation of feedback (2001), the frequency of BCS increased from 53% to 65% (p<0.001) and has remained elevated over 4 years (2002-2005). The respective frequencies of BCS at each facility also increased after the implementation of feedback. The difference between facility was the lowest frequency and facility with the highest frequency decreased from 35% (74%-39%) to 16% (75%-59%), a decrease of 53% in variation. In summary, integrated data from local cancer registries, the use of central performance reporting and feedback interventions resulted in a decreased variation and a sustained increase in the use of BCS across multiple facilities.