TY - JOUR
T1 - A statewide approach to reducing re-excision rates for women with breast conserving surgery
AU - Schumacher, Jessica R
AU - Lawson, Elise H
AU - Kong, Amanda L
AU - Weber, Joseph J
AU - May, Jeanette
AU - Landercasper, Jeffrey
AU - Hanlon, Bret
AU - Marka, Nicholas
AU - Venkatesh, Manasa
AU - Cartmill, Randi S
AU - Pavuluri Quamme, Sudha
AU - Nikolay, Connor
AU - Greenberg, Caprice C
AU - Complex General Surgical Oncology Faculty, Aurora
N1 - Schumacher JR, Lawson EH, Kong AL, et al. A Statewide Approach to Reducing Re-excision Rates for Women With Breast-conserving Surgery. Ann Surg. 2022;276(4):665-672. doi:10.1097/SLA.0000000000005590
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Objective: Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. Summary background: Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. Methods: Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change pre-to post-intervention between Surgical Collaborative of Wisconsin (SCW) and non-participating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included five collaborative meetings in 2018-2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. Results: In 2017, there were 3,692 breast procedures in SCW and 1,279 in non-participating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and non-participating hospitals (16.1% vs. 17.1%, P=0.47). Re-excision significantly decreased for SCW but not for non-participating hospitals (OR=0.69, 95%CI=0.52-0.91). Conclusions: Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for state-wide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.
AB - Objective: Test the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates. Summary background: Breast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target. Methods: Wisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change pre-to post-intervention between Surgical Collaborative of Wisconsin (SCW) and non-participating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included five collaborative meetings in 2018-2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided. Results: In 2017, there were 3,692 breast procedures in SCW and 1,279 in non-participating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and non-participating hospitals (16.1% vs. 17.1%, P=0.47). Re-excision significantly decreased for SCW but not for non-participating hospitals (OR=0.69, 95%CI=0.52-0.91). Conclusions: Benchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for state-wide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.
KW - breast conservation
KW - re-excision
UR - https://institutionalrepository.aah.org/auroragme/132
UR - https://libkey.io/libraries/1712/10.1097/SLA.0000000000005590
U2 - 10.1097/SLA.0000000000005590
DO - 10.1097/SLA.0000000000005590
M3 - Article
JO - Annals of surgery
JF - Annals of surgery
ER -