Abstract
BackgroundTreatment variation is an important issue in health care provision. An external peer review programme for multidisciplinary cancer care was introduced in 1994 in the Netherlands to improve the multidisciplinary organisation of cancer care in hospitals.So far the clinical impact of external quality assessment programmes such as external peer review and accreditation remains unclear. Our objective was to examine the degree of variation in treatment patterns and the possible effect of external peer review for multidisciplinary cancer care for breast cancer patients.MethodsPatients with breast cancer were included from 23 hospitals from two ‘intervention regions’ with the longest experience with the programme and 7 hospitals that never participated (control group). Data on tumour and treatment characteristics were retrieved from the Netherlands Cancer Registry. Treatment modalities investigated were: the completeness of breast conserving therapy, introduction of the sentinel node biopsy, radiotherapy after breast conserving surgery for ductal carcinoma in situ (DCIS), adjuvant radiotherapy for locally advanced breast cancer (T3/M0 or any T,N2-3/M0), adjuvant chemotherapy for early stage breast cancer (T1-2/N+/M0) and neo-adjuvant chemotherapy for T4/M0 breast cancer. Hospitals from the two intervention regions were dichotomised based on their implementation proportion (IP) of recommendations from the final reports of each peer review (high IP vs. low IP). This was regarded as a measure of how well a hospital participated in the programme.Results63,516 female breast cancer patients were included (1990-2010). Variation in treatment patterns was observed between the intervention regions and control group. Multidisciplinary treatment patterns were not consistently better for patients from hospitals with a high IP.ConclusionsThere is no relationship between the external peer review programme for multidisciplinary cancer care and multidisciplinary treatment patterns for breast cancer patients. Regional factors seem to exert a stronger effect on treatment patterns than hospital participation in external peer review.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-596) contains supplementary material, which is available to authorized users.
Highlights
Introduction of the sentinel node biopsy (SNB)N = 25612Inclusion criteria: cT1-2, cN0, cM0, Breast conserving surgery (BCS) North high implementation proportion (IP) 0.68* 0.55-0.84 North low IP 0.59* 0.50-0.70Rotterdam high IP 0 0.46* 0.38-0.55Rotterdam low IP 0 0.48* 0.40-0.57Radiotherapy after BCS for ductal carcinoma in situ (DCIS)
Design and patients Only female patients diagnosed with primary epithelial breast cancer (ICD-O 10, International Classification of Diseases, codes: C50.0 to 50.9) between 1 January 1990 and 31 December 2010 were selected from the Netherlands Cancer Registry (NCR)
Hospitals and recommendations Twenty-six hospitals from the Northern Netherlands and Rotterdam region were asked to give permission to use the data from their peer reviews and the Netherlands Cancer Registry
Summary
An external peer review programme for multidisciplinary cancer care was introduced in 1994 in the Netherlands to improve the multidisciplinary organisation of cancer care in hospitals. Our objective was to examine the degree of variation in treatment patterns and the possible effect of external peer review for multidisciplinary cancer care for breast cancer patients. It is known that treatment variation exists between and within countries and it is unknown whether and how these differences interact with improvement efforts This poses serious challenges in efforts to evaluate quality improvement programmes. After a self-assessment, on-site observation and interviews, the organisation of cancer care in a hospital is evaluated and recommendations for improvement are given. More information on the programme can be found in Additional file 1
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
