Administrative Memos

200110

FROM: Theodore O. Will, Chief Executive Officer
DATE: Aug 10, 2001
SUBJECT: Breast Cancer Practices Among Medicare Patients Undergoing Unilateral Extended Simple Mastectomy In New York State
IPRO CONTACTS:

Pascal James Imperato, M.D., M.P.H. & TM - ext. 532, Medical Director, Research Development & Epidemiology
Terri Straub, R.N., M.B.A. - ext. 548 Senior Director, Improvement Strategies/Quality Improvement

Enclosed please find a statewide report on "Breast Cancer Pathology Practices Among Medicare Patients Undergoing Unilateral Extended Simple Mastectomy in New York State." An unbound copy of this report is also enclosed to facilitate copying for the suggested distribution list. This quality improvement project was initiated in response to concerns expressed about the completeness of information contained in pathology reports on unilateral extended simple mastectomy specimens.

During 2000, IPRO worked with the members of its Breast Cancer Pathology Advisory Group (BCPAG) to design a project to assess the quality of pathology reports on unilateral extended simple mastectomy specimens for the period January 1 - December 31, 1999. The group suggested that the reports be examined for a number of quality indicators relevant to patient care. A retrospective chart review was conducted in 2000 of 555 Medicare patients who underwent the procedure during calendar year 1999.

Performance on six of seventeen quality indicators was 93.5% or better. Of particular concern was the finding of low performance levels of 69.4% or less on several other key quality indicators. Those of special concern because of their relevance to adjuvant therapy and prognosis include:

resection margin status
verification of tumor size on microscopic examination
histologic grade (and its related elements of mitotic rate, extent of tubule formation and nuclear grade)
angiolymphatic invasion

With regard to three of these quality indicators, histologic grade, resection margin status, and angiolymphatic invasion, performance levels were found to be significantly lower in this study than in similar studies conducted elsewhere.

The issues with breast cancer pathology reports identified in this study are amenable to improvement. Improved documentation in these reports will better serve treating physicians in making adjuvant treatment decisions, estimating prognosis and evaluating outcomes. It will also be of help to patients and their families in estimating prognosis and in making treatment and other life decisions.

We recommend that all hospitals review their breast cancer pathology reports in light of currently recommended protocols and develop quality improvement plans where indicated. These plans should address the quality indicator issues identified in this report. IPRO will be happy to work with individual hospitals and provide additional information when needed.

Should you have any questions about IPRO's Breast Cancer Pathology Study, please feel free to call the above contacts.