Table 1 Quality Indicators Used to Measure Adherence to Standards of Breast Cancer Care
Type of Quality Indicator | n | Extent of scientific development as a quality measure* |
|---|---|---|
Diagnosis | ||
Appropriate use of imaging, sampling (fine-needle or biopsy) within given time-frame | 8 | IV |
Adequacy of fine-needle biopsy samples | 1 | IV |
Receipt of frozen section of primary operable BC | 1 | IV |
Quality of surgical technique, sampling nodes | 2 | IV |
Quality of hormone receptor assay | 1 | IV |
Quality of life and patient satisfaction relating to diagnosis | 2 | Iac |
Appropriate referral to surgeon | 2 | IV |
Appropriate (timely) attendance at assessment centre, specialist appointment, surgery, receipt of information by patient | 5 | IV |
Efficient diagnosis (few visits to hospital) | 1 | IV |
Appropriate evaluation vis a vis guidelines, or at first visit | 2 | IV |
Appropriate specialist knowledge of surgeons | 1 | IV |
Treatment | ||
Appropriate surgical choices – breast conserving, mastectomy, lymph node dissection | 7 | IV |
Timely admission for therapeutic surgery | 1 | IV |
< 3 operations for breast-conserving surgery | 1 | IV |
Evidence of discussion of surgical options | 1 | IV |
Appropriate use, timeliness of initial radiotherapy | 6 | IV |
Quality of radiotherapy planning, fractionation, radiation field distribution | 7 | IV |
Regional recurrence | 1 | IV |
Appropriate use of radiotherapy for regional recurrence, palliation | 1 | IV |
Appropriate use (or not) of adjuvant systemic therapy | 23 | IV |
Chemotherapy quality of administration – dosages and availability of procedure manual | 2 | IV |
Quality of life, satisfaction with treatment | 6 | Ia, Iac |
Participation in decision-making, receipt of sufficient information re. treatment | 2 | IV |
Qualifications of doctors | 2 | IV |
Appropriate referrals to specialists | 2 | IV |
Appropriate treatment choices, sequences | 5 | IV |
Followup | ||
Appropriate followup mammography, use of guidelines | 2 | IV |
Recurrence within 5 years | 2 | IV |
Appropriate use of prophylactic radiotherapy in women with high risk of flap recurrence | 1 | IV |
Reporting/Documentation | ||
Pathology reporting/documentation | 42 | IV |
Imaging reporting/documentation – size of mammographic abnormality | 1 | IV |
Chemotherapy reporting/documentation | 2 | IV |