An overview of breast medical oncology documentation through the Florida Initiative on Quality Cancer Care (FIQCC): The Phase II 2009 results.

Abstract

73 Background: Following feedback provided to each site of their 2006 compliance results and enactment of improvement plans, the FIQCC re-evaluated the quality of documentation of specific quality indicators for breast cancer in the medical records of 11 participating FIQCC sites in 2009. Quality indicators were based upon ASCO, ACOS, NCCN, and expert-consensus panel recommendations. The findings were compared with 2006 results. Methods: Chart reviews from the same 2006 FIQCC sites for pre-specified Breast Medical Oncology quality indicators were performed by trained abstractors on patients first seen in 2009. The indicators included: clinical trial decisions, consent for treatment, definitive surgery after neo-adjuvant chemotherapy, published regimen dose plan, and chemotherapy selected from a published list. Statistical comparisons of 2006 and 2009 data were performed using the Pearson chi-square exact test based on Monte Carlo estimation. Results: 636 pts (99% female) [average age of 60.7 years (range 24-94)] were evaluated, with the 2009 number of cases per site ranging from 59 to 97. Significant improvements in treatment planning and administration were seen over time when comparing 2006 (n=602) to 2009 charts. This included signed chemotherapy consent (2006: 74%; 2009: 81% p=0.047), definitive surgery after neo-adjuvant chemotherapy (2006: 88%; 2009:100% p=0.017), and the planned dose being from a published list (2006: 74%;200: 84% p=0.020). Strides were also made in documenting that patients were evaluated for clinical trial enrollment (2006:13%; 2009: 21% p=0.001). Declines were seen in chemotherapy selections from an approved list (2006:94%; 2009: 82% p<0.001). Further investigations into this finding are underway and will be presented at the meeting. Conclusions: With the adoption of specific quality indicators, evaluation of a specified number of cases across multiple practices, and then providing feedback on documentation to providers and medical teams, here we demonstrate that significant improvements in medical charting and thus quality cancer care can be made.