Abstract
6545 Background: Compliance with National Initiative for Cancer Care Quality (NICCQ) quality indicators and National Comprehensive Cancer Network (NCCN) guidelines for breast cancer care are proposed measures of quality breast cancer care. Previously, we had determined NCCN guideline compliance rates for breast cancer care by physician review of electronic medical record (EMR). In the present study, we sought to compare NCCN guideline compliance and NICCQ adherence at our institution in regard to percent compliance, time taken to complete review, and comparison of physician reviewer (PR) versus non-physician reviewer (NPR). Methods: Review of the EMR was conducted for all 200 female patients who were newly diagnosed with breast cancer and treated at our multi-specialty institution in 2004. A PR and a NPR reviewed compliance with NICCQ quality indicators and NCCN guidelines for breast cancer care and time spent reviewing charts was recorded. Results: Adherence rate was less than 85% in only 7 of 36 NICCQ breast cancer quality measures for PR and only 6 of 36 for NPR. Patients overall received 91.5 % of NICCQ recommended care according to PR and 89.8% according to NPR. NICCQ measures were divided into categories to correspond with NCCN guideline categories and results are compared and summarized in the table below. Differences in observed compliance rates between PR and NPR were not significant for NCCN (except in pre-op workup where NPR was more accurate) or overall NICCQ audit, however differences were seen in individual NICCQ items with small numbers of patients. Average time for review of charts for NCCN guideline compliance vs. NICCQ adherence was not significantly different (6.8 vs. 6.3 minutes for PR and 8.3 vs. 8.9 minutes for the NPR). Conclusions: Our adherence rates for NICCQ and NCCN measures compare favorably with published values. Despite both being proposed quality measures, comparison of adherence rates for the two systems varied. PR is slightly faster than NPR but offset by PR's time value. A NPR performs as well, if not better, than a PR. No significant financial relationships to disclose. [Table: see text]
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