National Accreditation Program for Breast Centers Demonstrates Improved Compliance with Post-Mastectomy Radiation Therapy Quality Measure - 19/04/17

Doi : 10.1016/j.jamcollsurg.2016.11.006

Elizabeth R. Berger, MD, MS ^b,^d,^⁎ , Chihsiung E. Wang, PhD ^a,^e, Cary S. Kaufman, MD, FACS ^a,^f, Ted J. Williamson, MD, PhD, CTR ^a,^g, Julio A. Ibarra, MD ^a,^h, Karen Pollitt, BS ^a,^b, Richard J. Bleicher, MD, FACS ^a,ⁱ, James L. Connolly, MD ^a,^j, David P. Winchester, MD, FACS ^a,^c, Katharine A. Yao, MD, FACS ^a,^e
^a National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL
^b Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
^c Cancer Programs, American College of Surgeons, Chicago, IL
^d Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
^e Department of Surgery, NorthShore University HealthSystem, Evanston, IL
^f Department of Surgery, Bellingham Regional Breast Center, Bellingham, WA
^g Department of Radiation Oncology, Salem Hospital, Salem, OR
^h Department of Pathology, Orange Coast Memorial Medical Center, Fountain Valley, CA
ⁱ Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA
^j Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA

^∗Correspondence address: Elizabeth R Berger, MD, MS, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL 60153.Department of SurgeryLoyola University ChicagoStritch School of MedicineMaywoodIL60153

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.

Study Design

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.

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Abbreviations and Acronyms : CoC, NAPBC, NCDB, OR, PMRT