Using clinical cancer registry data for estimation of quality indicators: Results from the Norwegian breast cancer registry

Hartmann-Johnsen, Olaf Johan; Kåresen, Rolf; Schlichting, Ellen; Naume, Bjørn; Nygård, Jan F.

doi:10.1016/j.ijmedinf.2019.03.004

Cited by 23 publications

(37 citation statements)

References 22 publications

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“…Regarding pre-operative histological/cytological diagnosis, similar high compliance rates (93–98%) were observed in four recent European studies [20,21,23,29], while two studies that included in situ cancers found lower rates (86–88%) [22,26]. Another French study found perfect compliance, probably due to patient selection (i.e., operable early-stage BC patients managed in CCC, TH and general hospitals) [27].…”

Section: Discussionsupporting

confidence: 78%

“…In most European studies, reexcision rates were similar to ours [10,11,19,25,26], while American studies reported higher rates (25–40%) [30]. The Norwegian study reported lower reexcision rate (6%) in 2016 [29], in line with the rate decrease observed in another study between 2012 (14.6%) and 2015 (8.8%) [26]. For BCS, variation in compliance was found between studies and may be explained by stage and age differences in the analyzed populations.…”

Section: Discussionsupporting

confidence: 76%

“…Several studies were conducted before 2003, when guidelines and treatments differed than those currently in use. Out of all recent studies [9–29], the only few conducted at the population level [9–12,16,17,28,29] used recent data (after 2010) [28,29]. Five studies using EUSOMA QIs [22,24–27] were hospital-based and included patients from voluntary centers (often EUSOMA certified centers [22,24–26]), which may introduce selection biases and overestimate compliance.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of health system performance in BC care requires measuring of compliance in “real-life” situations. In 2019, two population-based studies on EUSOMA QIs for the management of BC diagnosed in 2013 and 2016 were conducted in Slovenia and Norway [28,29]. The results of these studies are difficult to generalize to French patients because of differences between health systems.…”

Section: Discussionmentioning

confidence: 99%

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Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Cowppli-Bony

Trétarre²,

Marrer³

et al. 2019

PLoS ONE

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BackgroundThe European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in “real-life” situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France.Methods1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging.ResultsThe minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment.ConclusionThis study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Cowppli-Bony

Trétarre²,

Marrer³

et al. 2019

PLoS ONE

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“…The RKKP in Denmark, the CRN in Norway and the RCCs in Sweden contribute to benchmarking studies with indepth analyses aimed at investigating and explaining differences in patient outcome between subsets of patients and between different regions and countries. Some registries have aligned their process indicators with international guidelines, e.g., the Swedish and the Norwegian breast cancer registries that aligns several varaibles and target levels with the EUSOMA guidelines [81,82]. In Denmark, clinical registry data also contribute to European benchmarking initiatives such as EURECCA, EU-MELACARE and EPID and have documented treatment variability, survival patterns and outcome in specific subsets such as elderly patients [83,84].…”

Section: Benchmark Studiesmentioning

confidence: 99%

The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care

Nilbert

Thomsen

Jensen³

et al. 2020

Acta Oncologica

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Background: In Scandinavia, there is a strong tradition for research and quality monitoring based on registry data. In Denmark, Norway and Sweden, 63 clinical registries collect data on disease characteristics, treatment and outcome of various cancer diagnoses and groups based on process-related and outcome-related variables. Aim: We describe the cancer-related clinical registries, compare organizational structures and quality indicators and provide examples of how these registries have been used to monitor clinical performance, develop prediction models, assess outcome and provide quality benchmarks. Further, we define unmet needs such as inclusion of patient-reported outcome variables, harmonization of variables and barriers for data sharing. Results and conclusions: The clinical registry framework provides an empirical basis for evidencebased development of high-quality and equitable cancer care. The registries can be used to follow implementation of new treatment principles and monitor patterns of care across geographical areas and patient groups. At the same time, the lessons learnt suggest that further developments and coordination are needed to utilize the full potential of the registry initiative in cancer care.

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Quality Indicators for the Diagnosis and Management of Primary Hyperparathyroidism

Noltes

Cottrell

Madani

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Primary hyperparathyroidism (pHPT) is a common endocrine disorder with many diagnostic and treatment challenges. Despite high-quality guidelines, care is variable, and there is low adherence to evidence-based treatment pathways.OBJECTIVE To develop quality indicators (QIs) to evaluate the diagnosis and treatment of pHPT that could measure, improve, and optimize quality of care and outcomes for patients with this disease. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study used a guideline-based approach to develop QIs that were ranked by a Canadian 9-member expert panel of 3 endocrinologists, 3 otolaryngologists, and 3 endocrine surgeons. Data were analyzed between September 2020 and May 2021.MAIN OUTCOMES AND MEASURES Candidate indicators (CIs) were extracted from published primary hyperparathyroidism guidelines and summarized with supporting evidence. The 9-member expert panel rated each CI on the validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND-University of California, Los Angeles appropriateness methodology. All panelists were then asked to rank the top 5 QIs for primary, endocrine, and surgical care.RESULTS Forty QIs were identified and evaluated by the expert panel. After 2 rounds of evaluations and discussion, a total of 18 QIs were selected as appropriate measures of high-quality care. The top 5 QIs for primary, endocrine, and surgical care were selected following panelist rankings. CONCLUSIONS AND RELEVANCEThis quality improvement study proposes 18 QIs for the diagnosis and management of pHPT. Furthermore, the top 5 QIs applicable to physicians commonly treating pHPT, including general physicians, internists, endocrinologists, otolaryngologists, and surgeons, are included. These QIs not only assess the quality of care to guide the process of improvement, but also can assess the implementation of evidence-based guideline recommendations. Using these indicators in clinical practice and health system registries can improve quality and cost-effectiveness of care for patients with pHPT.

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Using clinical cancer registry data for estimation of quality indicators: Results from the Norwegian breast cancer registry

Cited by 23 publications

References 22 publications

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care

Quality Indicators for the Diagnosis and Management of Primary Hyperparathyroidism

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