Quality assurance in oncology: Benchmarking breast cancer care across multidisciplinary breast centres - An analysis of the 2003-2006 quality indicators, in collaboration with the Deutsches Onkologie Centrum (WBC/DOC)

Purpose: This was a prospective interventional multicentre study to establish a supraregional collaborative network of breast centres with an external, independent provider of data analysis services; to provide proof of concept for the self-declaration, centralised collection and independent analysis of relevant quality assurance (QA) data and define suitable quality indicators (QIs) for benchmarking the quality of breast cancer (BC) care; to develop a generic uniform XML-based QA data set; and to demonstrate existing differences in BC care quality and the verifiability of QA. Another objective was to show that benchmarking improved BC care quality even during the first 4-year period, 2003 - 2006. Methods: Initiated in 2003, data collection depended on voluntary participation of BC centres in a commercial benchmarking procedure conducted by an independent external institute (WBC). Patient data were anonymised, encrypted and submitted for analysis twice a year. Nine guideline-based clinical parameters designed to assess attainment of predefined quality targets were defined as rate-based QIs. These were reviewed annually by the data advisory board and modified or expanded. QI changes over time were analysed descriptively. Results: During 2003 - 2006, participating breast centres increased from 59 to 202 (342%), documented breast cancers from 5453 to 25417 (466%; about 50% of annual BC incidence in Germany). Additionally, a system-independent uniform XML-based data set was developed. Based on 9 process QIs in 2003, 12 QIs and 15 sub-indicators were developed by 2006 as surrogates for outcome (morbidity, mortality), which will be measurable after 5 - 10 years at the earliest. Conclusion: Supraregional external benchmarking of BC care is feasible and successful. Marked QI increases indicate improvements in BC care quality.