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Teberian I, Kaufman T, Shames J, Rao VM, Liao L, Levin DC. Trends in the Use of Percutaneous Versus Open Surgical Breast Biopsy: An Update. J Am Coll Radiol 2020; 17:1004-1010. [DOI: 10.1016/j.jacr.2020.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
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Javid SH, Anderson BO. Delayed Adoption of Evidence-Based Breast Cancer Surgical Practices: History Repeats Itself. JAMA Oncol 2019; 4:1517-1518. [PMID: 30003240 DOI: 10.1001/jamaoncol.2018.1939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sara H Javid
- Department of Surgery, University of Washington, Seattle
| | - Benjamin O Anderson
- Department of Surgery, University of Washington, Seattle.,Department of Global Health-Medicine, University of Washington, Seattle
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Landercasper J, Fayanju OM, Bailey L, Berry TS, Borgert AJ, Buras R, Chen SL, Degnim AC, Froman J, Gass J, Greenberg C, Mautner SK, Krontiras H, Ramirez LD, Sowden M, Wexelman B, Wilke L, Rao R. Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters. Ann Surg Oncol 2018; 25:501-511. [PMID: 29168099 PMCID: PMC5758679 DOI: 10.1245/s10434-017-6257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance. STUDY DESIGN Surgeons entered QM data into an electronic registry. For each QM, aggregate "performance met" (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method. RESULTS A total of 1,286,011 QM encounters were captured from 2011-2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a "never should occur" event. CONCLUSIONS Surgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded "perfect" performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.
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Affiliation(s)
| | | | - Lisa Bailey
- Bay Area Breast Surgeons, Inc, Oakland, CA, USA
| | | | | | | | | | | | | | | | - Caprice Greenberg
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | | | | | | | | | | | - Lee Wilke
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | - Roshni Rao
- Columbia University Medical Center, New York, NY, USA
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Landercasper J, Bailey L, Buras R, Clifford E, Degnim AC, Thanasoulis L, Fayanju OM, Tjoe JA, Rao R. The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters. Ann Surg Oncol 2017; 24:3093-3106. [PMID: 28766206 PMCID: PMC5594033 DOI: 10.1245/s10434-017-5940-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND To identify and remediate gaps in the quality of surgical care, the American Society of Breast Surgeons (ASBrS) developed surgeon-specific quality measures (QMs), built a patient registry, and nominated itself to become a Center for Medicare and Medicaid Services (CMS) Qualified Clinical Data Registry (QCDR), thereby linking surgical performance to potential reimbursement and public reporting. This report provides a summary of the program development. METHODS Using a modified Delphi process, more than 100 measures of care quality were ranked. In compliance with CMS rules, selected QMs were specified with inclusion, exclusion, and exception criteria, then incorporated into an electronic patient registry. After surgeons entered QM data into the registry, the ASBrS provided real-time peer performance comparisons. RESULTS After ranking, 9 of 144 measures of quality were chosen, submitted, and subsequently accepted by CMS as a QCDR in 2014. The measures selected were diagnosis of cancer by needle biopsy, surgical-site infection, mastectomy reoperation rate, and appropriateness of specimen imaging, intraoperative specimen orientation, sentinel node use, hereditary assessment, antibiotic choice, and antibiotic duration. More than 1 million patient-measure encounters were captured from 2010 to 2015. Benchmarking functionality with peer performance comparison was successful. In 2016, the ASBrS provided public transparency on its website for the 2015 performance reported by our surgeon participants. CONCLUSIONS In an effort to improve quality of care and to participate in CMS quality payment programs, the ASBrS defined QMs, tracked compliance, provided benchmarking, and reported breast-specific QMs to the public.
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Affiliation(s)
| | - Lisa Bailey
- Bay Area Breast Surgeons, Inc., Oakland, CA, USA
| | | | - Ed Clifford
- Baylor Scott and White Healthcare, Dallas, TX, USA
| | | | | | | | | | - Roshni Rao
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Matulewicz RS, Tosoian JJ, Stimson CJ, Ross AE, Chappidi M, Lotan TL, Humphreys E, Partin AW, Schaeffer EM. Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy. J Urol 2016; 197:1245-1250. [PMID: 27916711 DOI: 10.1016/j.juro.2016.11.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Success in the era of value-based payment will depend on the capacity of health systems to improve quality while controlling costs. Comparative quality performance review can be used to drive improvements in surgical outcomes and thereby reduce costs. We sought to determine the efficacy of a comparative quality performance review to improve a surgeon-level measure of surgical oncologic quality, that is the positive surgical margin rate at the time of radical prostatectomy. MATERIALS AND METHODS Eight surgeons who performed consecutive radical prostatectomies at a single high volume institution between January 1, 2015 and December 31, 2015 were included in analysis. Individual surgeons were provided with confidential report cards every 6 months detailing their case mix, case volume and pT2 radical prostatectomy positive surgical margin rate relative to 1) their own self-matched data, 2) the de-identified data of their colleagues and 3) institutional aggregate data during the study period. Positive surgical margin rates were compared before and after intervention. Hierarchal logistic regression analysis was used to examine the association of study period on the odds of positive surgical margins, adjusted for prostate specific antigen level and National Comprehensive Cancer Network® risk group. RESULTS Overall, 1,822 (1,392 before and 430 after intervention) radical prostatectomies were performed that met study inclusion criteria. The aggregate departmental unadjusted positive surgical margin rates were 10.6% and 7.4% in the pre-intervention and post-intervention groups, respectively. After adjusting for higher risk cancer in the post-intervention group, there was a significant protective association of post-intervention status on positive margins (OR 0.64, 95% CI 0.43-0.97, p = 0.03). All 5 surgeons with positive surgical margin rates higher than the aggregate department rate in the pre-intervention period showed improvement after intervention. CONCLUSIONS Comparative quality performance review can be implemented at the surgeon level and can promote improvement in an objective measure of surgical oncology quality.
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Affiliation(s)
- Richard S Matulewicz
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jeffrey J Tosoian
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - C J Stimson
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Meera Chappidi
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Tamara L Lotan
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Elizabeth Humphreys
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Alan W Partin
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
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