Abstract

6016 Background: There has been no research evaluating provider level variation in patient appraisal of 3 key indicators of quality breast cancer care defined by ASCO: timely access, care coordination, and decision satisfaction. Methods: 3,133 women with nonmetastatic breast cancer diagnosed from 6/05-2/07 and reported to the Detroit and Los Angeles SEER registries were identified and surveyed after diagnosis. Latina and African American (AA) women were oversampled (N=2,268, response rate 72.4%). Patient survey and SEER data were merged with surveys of attending surgeons (N=311). Three multi-item patient-reported scales were adapted from ASCO's national initiative on cancer care quality: 1) timely access to care; 2) perceived care coordination; 3) decision satisfaction. Each continuous outcome (range 1 to 5) was analyzed using hierarchical regression to determine the amount of total variation explained by surgeons. Subsequent stepwise models controlled for patient factors (clinical and demographic), surgeon characteristics (specialization, gender, age), and two novel surgeon practice process measures (multidisciplinary communication scale, patient decision support scale). Results: Mean scores for the 3 outcomes were 4.2, 3.9 and 4.1 for access, coordination, and decision satisfaction. Individual surgeons explained a very small amount of the total variation in patient-reported timely access (4.7%), care coordination (3.8%), and decision satisfaction (1.3%) after controlling for patient factors. Adding surgeon characteristics and practice process measures to the models did not substantially affect between-surgeon variation in any of the outcomes (Table). Conclusions: Patients' appraisals of ASCO-based quality indicators for breast cancer were generally high. There was little surgeon influence on total variation in quality scores after controlling for patient factors. Surgeon practice processes appear to contribute minimally to patient perceptions of these quality measures. Amount of total variation in quality indicators explained by surgeons (%) Controlling for: Access Coordination Decision satisfaction Patient factors 4.7 3.8 1.3 Surgeon characteristics 4.3 2.1 0.6 Practice process measures 4.1 2.4 0.2 No significant financial relationships to disclose.

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