Despite African American (AA) women in the US and Chicago having a lower incidence of breast cancer compared to White women, AA women are more likely to die of the disease. The situation is especially concerning in Chicago where the disparity is one of the highest in the country with AA women being 62% more likely to die of breast cancer compared to White women. Both national and Chicago-specific data suggests that differential quality of breast health care between the two groups plays a role in the disparity.
Against this backdrop, the Chicago Breast Cancer Quality Consortium was established in 2008 to bring area providers together to share breast cancer quality screening and treatment data with the aim of analyzing whether disparities in quality were contributing to disparities in outcomes and to improve quality where quality deficits were identified. Expert advisory boards established for mammography and treatment developed consensus on collection methods and quality measures. Highest priority was given to measures of clinical outcomes that could be feasibly estimated through collection of aggregate data from all participating facilities, including those with the lowest resources who disproportionately serve minority women. Standardized forms were developed to record specific counts, and then entered onto a secure web-based portal. Measures for screening included cancer detection rate, proportion of cancers found that were minimal, proportion of cancers found that were early stage, timeliness of follow up after an abnormal mammogram and recall rate. Measures for treatment included proportion of patients receiving radiation after breast conserving surgery, proportion of patients tested for ER and PR, proportion of patients tested for HER-2, proportion of Her-2 positive patients who were treated with trastuzumab, and timeliness of treatment after diagnosis. Data on screening (39 facilities) and/or treatment quality metrics (21 facilities) was submitted by 43 of the 67 Metropolitan Chicago hospitals with mammography volume above 480 per year. Information regarding patient demographics including payor mix and race/ethnicity for both inpatient and outpatient services at each participating facility was derived from data reported annually to the Illinois Department of Public Health (IDPH) hospital profiles.
Results from this first year of data collection will be presented and include the following results: Only 3 of the 10 benchmarks were shown to be met by half or more of the facilities examined. None of the 10 benchmarks were shown to be met by two-thirds or more of the facilities examined. The benchmark for recall rate was shown to be met by the largest percentage of facilities (62%), followed by cancer detection rate (39%) and lost to follow-up at diagnostic imaging (54%). Almost one third (28%) of facilities were able to show that they met the benchmarks for proportion minimal breast cancers, and about one fourth (26%) were able to show that they met standards for proportion early stage breast cancers. From these data it is clear that facilities are having difficulty meeting the benchmark values, and gathering and tracking the data necessary to be able create reliable estimates that could form the basis of quality improvement initiatives. Several of these measures are essential for a facility to be able to review its mammography quality (both image quality and reading effectiveness) and timeliness of follow up.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A101.