National Accreditation Program For Breast Centers Research Articles

Just ASK: A quality improvement project to enhance smoking assessment and treatment.

6571 Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all < 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. [Table: see text]

Impact of geographic distribution of accredited breast centers.

The National Accreditation Program for Breast Centers (NAPBCs) is dedicated to improving the quality of care in patients with breast disease. Geographic distribution of health care resources is an important measure of quality, yet little is known regarding breast center allocation patterns concerning population demand and impact on health outcomes. The purpose of this study was to analyze the distribution of NAPBC programs in the United States (USA) and evaluate the impact on breast cancer survival. Using the Centers for Disease Control and Prevention 2014 data base, we identified the incidence and mortality rates for breast cancer by state. We also determined the concentration of NAPBC programs in each state (ie, the number of centers per 1000 cases of breast cancer). Data were analyzed using Spearman's (nonparametric) rank correlation coefficients. Five hundred and seventy NAPBC programs were identified. Across the United States, there was a mean of 2.8 programs/1000 breast cancer diagnoses. A positive correlation (r=.45) between breast cancer incidence and the number of programs was identified (P=.0009). There was no statistically significant correlation between mortality and NAPBC program concentration (r=-0.20, P=.16). NAPBC-accredited program distribution within the United States correlates with breast cancer incidence per state. However, the number of NAPBC programs per state did not alter overall mortality rates. Added measures beyond survival, as well as further insight into referral patterns to NAPBC programs, may be required to demonstrate the value and impact of NAPBC accreditation.

Abstract P6-15-01: Military sexual trauma is associated with an increased prevalence of mastectomy versus breast conserving surgery in a population of female veterans with early stage breast cancer

Abstract Background: The National Accreditation Program for Breast Centers (NAPBC), in a 2014 statement of standards, endorsed breast conservation surgery (BCS) for women with AJCC stage 0,I, or II breast cancer, with a target of 50% BCS. Women comprise the fastest growing segment of Veteran's Health Administration (VA) enrollees, and have high rates of trauma exposure including military sexual trauma (MST). The VA conducts universal screening of all Veterans for MST. Implications for medical care, e.g. an increased rate of hysterectomy among survivors of MST, have been reported. While the numbers of breast cancers treated in VA are relatively small compared to non-VA centers, a trend toward decreasing rates of BCS in VA from 2000-2006 has been reported. Reasons for declining rates of BCS within VA, and the lower rates of BCS in the VA compared to the private sector remain unclear. The objective of this study was to identify determinants of mastectomy versus BCS in women Veterans with early stage breast cancer and to examine whether history of MST was associated with choice of mastectomy versus BCS. Methods: As a quality improvement study, we conducted a retrospective review of all early-stage (0,I,II) female breast cancer patients identified in the tumor registry between 2006-2015 at one Northeastern VA to determine rates of mastectomy and BCS. Through chart review, we examined potential determinants of BCS including age, stage, distance from treating VA facility, genetic testing, contralateral prophylactic mastectomy, and reconstructive surgery. History of MST was documented through chart review. Analyses were performed using unpaired t-test for age and distance from treatment facility and Fisher's exact test for significance comparing history of MST between surgical groups. Results: 70 women with early stage breast cancer were eligible for BCS. Of these, 39 underwent BCS and 31 underwent mastectomy (55% rate of BCS). Age and distance to treating VA were not significant. Women who underwent mastectomy were on average younger (p=0.21) and lived farther away (p =0.42) and were more likely to undergo genetic testing. Of the women who underwent genetic testing (10/70), none had mutations. The biggest difference seen between surgical groups was in history of MST, with women in the mastectomy group having more than twice the prevalence of MST, 58%, vs 31% in the BCS group (p = 0.0154 ). Patient characteristics by type of surgery performed BCS N=39Mastectomy n=31Age (mean)63.559.3Distance from VA56.7 miles67.7 milesGenetic testing (no mutations found)4 (10%)6 (19%)Reconstructive surgery05Prophylactic contralateral mastectomy011MST11(28%)18(58%) Conclusion: These data suggest that MST is associated with choice of mastectomy over BCS. MST results in poor body image which may impact decisions about breast surgery. Trauma-informed strategies for counseling women about options for surgical management of early stage breast cancer may be needed to ensure that women with MST and other forms of trauma pursue evidence-based cancer treatment. Further work with a larger cohort is needed to better understand these findings. Citation Format: Oshry LJ, Naomi K, Megan GR. Military sexual trauma is associated with an increased prevalence of mastectomy versus breast conserving surgery in a population of female veterans with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-15-01.

Impact of Breast Center Accreditation on Compliance with Breast Quality Performance Measures at Commission on Cancer-Accredited Centers.

This study was designed to determine whether accreditation by the National Accreditation Program for Breast Centers (NAPBC) is associated with improved performance on six breast quality measures pertaining to adjuvant treatment, needle/core biopsy, and breast conservation therapy rates at Commission on Cancer (CoC) centers. National Cancer Database 2015 data were retrospectively reviewed to compare patients treated at CoC centers with and without NAPBC accreditation for compliance on six breast cancer quality measures. Mixed effects modeling determined performance on the quality measures adjusting for patient, tumor, and facility factors. Of 1308 CoC facilities, 484 (37%) were NAPBC-accredited and 111,547 patients (48%) were treated at NAPBC centers. More than 80% of patients treated at both NAPBC and non-NAPBC centers received care in compliance with breast quality measures. NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level and on five of six measures at the facility level. For two measures, needle/core biopsy before surgical treatment of breast cancer and breast conservation therapy rate of 50%, NAPBC centers were twice as likely as non-NAPBC centers to perform at the level expected by the CoC (respectively odds ratio [OR] 1.96, 95% confidence interval [CI] 1.85-2.08, p < 0.0001; and OR 2.05, 95% CI 1.94-2.15, p < 0.0001). While NAPBC accreditation at CoC centers is associated with higher performance on breast quality measures, the majority of patients at all centers receive guideline-concordant care. Future studies will determine whether higher performance translates into improved oncologic and patient-reported outcomes.

Treatment delays from transfers of care and their impact on breast cancer quality measures.

Despite delays between diagnosis and surgery adversely affecting survival, patients frequently transfer their breast cancer care between institutions. This study was performed to assess the prevalence and effect of such transfers of care (TsOC) on the time to surgery, and its impact on current time-dependent breast cancer quality metrics at Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC)-accredited institutions. Patients having non-metastatic invasive breast cancer diagnosed between 2006 and 2015 at CoC and NAPBC centers ("reporting facilities") in the National Cancer Database were reviewed. TsOC refer to transferring into or out of a reporting facility between diagnosis and surgery. Among 622,793 patients, 36.6% of patients transferred care. TsOC add 7.3, 7.8, 8.7, and 9.8 days in time to surgery, chemotherapy, radiotherapy, and endocrine therapy, respectively (p's < 0.0001). On multivariable analysis, the odds of surgery occurring > 90 days from diagnosis were greatest for patients undergoing unilateral or bilateral mastectomy, Black or Hispanic patients, and those having TsOC (ORs > 1.73, p's < 0.0001). TsOC increase the odds of non-compliance, per patient, for chemotherapy, radiotherapy and endocrine therapy time-dependent measures by 65.4%, 25.6%, and 56.5%, respectively (p < 0.0001). TsOC for newly diagnosed breast cancers to or from an accredited facility result in delays in time to surgery which can affect compliance with time-dependent quality measures. Facilities frequently receiving transferred patients may be most adversely affected. Although non-compliance with these quality measures is low, institutions and accrediting bodies should be aware of these associations in order to comply with time-dependent standards.

Abstract P6-12-10: The importance of a survivorship coordinator role in the creation of survivorship care plans and maintaining compliance with new accreditation standards

Abstract Background: Froedtert Hospital and the Medical College of Wisconsin's Breast Care Center (F&amp;MCWBCC), is a Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC) accredited facility providing care to over 500 patients a year. The F&amp;MCWBCC recognized the importance of following the IOM survivorship recommendations and in 2014 began providing a survivorship care plan (SCP) to patients completing radiation therapy. In 2015, SCP standards for both CoC and NAPBC were established. A redesign of the process was necessary to meet these new requirements. Methods: A review of accreditation standards was conducted along with an examination of staff availability. A collaborative team of content experts was gathered who worked with an informatics nurse to design content and a template in the EHR that met the elements outlined by the accreditation standards. Initially, treating physicians and advanced practice nurses were responsible for creating the SCP. However, these providers found it to be increasingly difficult to manage on top of their other responsibilities. In May 2015, an experienced breast cancer technician was identified for the survivorship data coordinator role. The coordinator used available sources, patient lists and clinic schedules, to case find. She developed spreadsheets to assist in tracking patients and measuring compliance. The coordinator communicated with providers to alert them to populate and review the SCP and coordinated the survivorship appointment with the nurse. Once the SCP is completed, a dedicated RN position is utilized for a survivorship visit with patients. During this visit, the RN reviews the care plan and provides education on follow up care guidelines and overall health and wellness concepts. Assessments for further supportive services are performed, and appropriate referrals made. The RN shares the SCP with the primary care provider. Results are tracked and reported to Cancer Service Line Leadership and the Breast Steering and Cancer Committees. Results: During the implementation phase, completion of SCPs by physicians and advance practice nurses was inconsistent. Once the survivorship coordinator role was created and implemented, compliance with NAPBC standards improved as SCP delivery numbers increased 141%. The survivorship coordinator improved delivery of SCPs. In 2014, 130 plans were delivered, and 185 in 2015. In 2016, 314 were delivered, achieving 100% compliance to the NAPBC survivorship standard. Conclusion:Compliance with NAPBC and CoC standards to deliver SCPs to patients and primary care providers is labor intensive and requires a large number of resources. Use of a survivorship data coordinator has proven successful in determining and tracking eligible patients and ensuring timely delivery of SCPs to patients. The monitoring of new patients through this process has enabled this center to go from estimates of analytic cases, to a current real-time numbers. This is necessary to provide a comprehensive review of care and survivorship guidelines to cancer survivors and meeting accreditation standards. Further work is needed to assess the impact of the SCPs on patient outcomes and satisfaction. Citation Format: Blissitt J, Scalio R, Myers KB, Sweeney K, Kelly TR, Kong A, Chitambar C, Currey AD. The importance of a survivorship coordinator role in the creation of survivorship care plans and maintaining compliance with new accreditation standards [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-10.

Use of telemedicine in the delivery of survivorship care plans among breast cancer survivors: Lessons learned at Kaiser Permanente East Bay.

77 Background: Beginning in 2015, the National Accreditation Program for Breast Centers (NAPBC) requires accredited facilities to provide Survivorship Care Plans (SCP) to breast cancer patients treated with curative intent. Here we describe lessons learned with the use of telemedicine in the delivery of SCPs at Kaiser Permanente East Bay. Methods: SCP implementation followed a two-step process: patients who are diagnosed and complete treatment in 2016 are given a SCP at their last surgical or medical oncology appointment (YTD, n=8); 2) patients diagnosed in 2015 who completed treatment in 2015-2016 were contacted by a physician assistant and offered an appointment by telephone or in-person to deliver the care plan (n=152). Both clinic and telemedicine appointments consist of a detailed review of treatment received, post-treatment follow-up care, discussion of health education resources, and provision of referrals as appropriate. Patients also have the opportunity to ask questions about treatment and follow-up care. Results: Among patients diagnosed in 2015 who were offered a TAV or in-person visit, 44.0% preferred a telephone appointment. Actual appointment duration ranged from 10 to 30 minutes. Lack of co-payment and fees associated with transportation as well as loss of income due to taking time off work were the primary factors cited choosing telemedicine over in-person clinic appointments. Interestingly, no differences in member satisfaction scores for in-person vs. telephone visits were observed. Conclusions: Findings suggest telemedicine may be effective in the delivery of SCPs. Similar to rural settings, use of telemedicine in urban settings has a unique capacity to increase service to breast cancer patients.

Abstract C18: Are facility characteristics where the patient initially presented associated with breast cancer diagnostic and treatment outcomes? Implications for racial/ethnic disparities in breast cancer outcomes

Abstract Background: Non-Latina (nL) Black and Latina breast cancer patients are more likely to be diagnosed at later stages and to experience shorter survival, compared to their nL White counterparts. Many studies, both nationally and in Chicago, have documented racial/ethnic disparities in many aspects of screening, diagnosis, and treatment for breast cancer, but few have examined the role of the facility where the problem that was later diagnosed as breast cancer was initially brought to medical attention (presentation facility). Prior research, as part of the Breast Cancer Care in Chicago (BCCC) study, found that breast cancer patients who initially presented at more highly accredited facilities and at higher-resource facilities were less likely to experience a prolonged diagnostic delay, and that meaningful racial/ethnic disparities in delay could be accounted for by differences in presentation facility. While this result highlights the potential influence of presentation facility on a proximal outcome (diagnostic delay), the present analysis aimed to further examine associations with the types of diagnostic work-up and treatment delays. Methods: In the BCCC (2005-2008), 989 newly diagnosed nL White, nL Black, and Latina patients with a first primary in-situ or invasive breast cancer, aged 30-79 at diagnosis were interviewed. Of these, 848 provided consent for medical record abstraction, and so were included in these analyses. Four characteristics of presentation facilities were examined: disproportionate share hospital (DSH) status (a marker of high Medicaid and uninsured volume), certification as a Breast Imaging Center of Excellence (BICOE), membership in the National Consortium of Breast Centers (NCBC), and the National Accreditation Program for Breast Centers (NAPBC). Outcomes representing potential indicators of quality of care included receipt of surgical versus core biopsy, sentinel node vs. axillary dissection, re-excision versus not, mastectomy versus lumpectomy, and prolonged radiation (&amp;gt;90 days), chemotherapy (&amp;gt;90 days) and overall treatment delay (&amp;gt;60 days). P-values for crude analyses were based on χ2 tests of associations. Results: NL Black and Latina patients were more likely than Whites to present at a DSH facility (38% and 48% vs 12%; p&amp;lt;0.001) and less likely to present at a BICOE (45% and 49% vs. 79%, p&amp;lt;0.001) or NAPBC facility (22% and 10% vs. 53%, p&amp;lt;0.001). Presentation at a BICOE facility was inversely associated with surgical biopsy (4% vs 11%; p&amp;lt;0.001), and presentation at a NAPBC facility was positively associated with receipt of a sentinel node biopsy (68% vs 55%; p=0.003). Presentation at a DSH facility was associated with surgery delay (23% vs 13%; p=0.002) and radiation delay (69% vs 53%; p=0.005) whereas presentation at a BICOE facility was inversely associated with overall treatment delay (12% vs 20%; p=0.003) and surgery delay (14% vs 21%; p=0.01). Presentation at a NAPBC facility was inversely associated with overall treatment delay (6% vs 19%; p&amp;lt;0.001), surgery delay (9% vs 20%; p=0.001), and radiation delay (37% vs 62%; p&amp;lt;0.001) but positively associated with chemotherapy delay (81% vs 65%; p=0.003). Conclusion: Presentation facility characteristics were associated with several aspects of diagnosis and treatment quality indicators. Results implicate a role of presentation facility in diagnostic and treatment-related quality. Limitations that will be addressed in subsequent analyses include multivariable adjustment of patient and tumor factors that might influence these associations. Citation Format: Alejandro Hughes, Abigail Silva, Anne-Marie Murphy, Garth Rauscher. Are facility characteristics where the patient initially presented associated with breast cancer diagnostic and treatment outcomes? Implications for racial/ethnic disparities in breast cancer outcomes. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C18.

National Accreditation Program for Breast Centers Demonstrates Improved Compliance with Post-Mastectomy Radiation Therapy Quality Measure

The National Accreditation Program for Breast Centers (NAPBC) was established in 2008 by the American College of Surgeons as a quality-improvement program for patients with breast disease. An NAPBC quality measure states post-mastectomy patients with ≥4 positive lymph nodes should receive lymph node radiation therapy (PMRT). Our objective was to examine how NAPBC accreditation has affected compliance with this quality measure. Women who underwent mastectomy at either an NAPBC-accredited center or a Commission on Cancer-only accredited hospital were identified (2006 to 2013) in the National Cancer Data Base. The NAPBC centers accredited from 2009 to 2011 were included in the analysis. Patients were nested within centers using a mixed effects model to identify PMRT rates at each center before and after accreditation, adjusting for patient and tumor characteristics. Of 34,752 patients from 477 NAPBC-accredited centers and 958 Commission on Cancer-only accredited hospitals who underwent mastectomy with ≥4 positive lymph nodes, 21,638 patients received PMRT during the study period (62.3%). The NAPBC centers yielded a significantly higher rate of PMRT than Commission on Cancer hospitals (66.0% vs 59.2%; p < 0.001). For each year of accreditation (2009 to 2011), centers had significantly higher rates of radiation in the accreditation year compared with the year before accreditation (p < 0.001). Within those centers, the rate of radiation increased post-accreditation in each accreditation year (2009: 62.1% to 71.9%; 2010: 65.5% to 73.2%; 2011: 67.5% to 70.4%). The NAPBC accreditation is associated with higher PMRT rates and better adherence to the PMRT quality measure. Future studies with more centers and longer follow-up are needed to determine whether this trend continues.

Abstract C31: Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study

Abstract Background: Lymph node biopsy is a critical component of a diagnostic work-up for patients with invasive breast cancer and is necessary for evaluating the extent and stage of disease so that appropriate treatment can be recommended. The standard procedure prior to the advent of sentinel lymph node biopsy (SLNB) procedures was axillary lymph node dissection (ALND), which is associated with debilitating side effects such as lymphedema. SLNB diffused into practice during the early 2000s and is associated with fewer side effects; for this reason, SLNB has become the standard of care for women diagnosed with invasive breast cancer without clinically palpable lymph node involvement. Using data from the Breast Cancer Care in Chicago study (BCCC), we investigated racial/ethnic disparities in the receipt of SLNB vs. ALND and whether certain tumor, patient, or facility characteristics might help to explain the likelihood of receiving a SLNB. Methods: A total of 989 female patients newly diagnosed with breast cancer were recruited and interviewed for the study. Eligible patients were female, resided in Chicago, had a first primary in situ or invasive breast cancer; were diagnosed between 2005 and 2008 between the ages of 30 and 79 at diagnosis; and self-identified as either non-Latina (nL) White, nL Black or Latina. Of these, 74% (N=731) consented to medical record abstraction and had complete information on receipt of either ALND or SLNB. The racial/ethnic disparity in receipt of SLNB was estimated as a prevalence difference (PD) using logistic regression with marginal based standardization. Mediation analyses were conducted using the method of rescaled coefficients (Karlson, Holm, and Breen). All models were adjusted for age at diagnosis. Results: Roughly half of patients (57%) received a SLNB; nL White women were more likely to receive a SLNB as compared to nL Black and Hispanic women (67% vs 50% and 50%; p=&amp;lt;.001). The prevalence of SNLB was 33%, 75%, 70%, 38% and 20% for stage 0, 1, 2, 3 and 4 breast cancer (p&amp;lt;0.0001) and was higher for ER/PR positive versus negative tumors (p&amp;lt;0.0001) and decreased with increasing tumor grade (p=0.007). SLNB did not vary appreciably for patients who were uninsured, publicly insured or privately insured and SLNB was more common for patients diagnosed at facilities with accreditations from the National Accreditation Program for Breast Centers (NAPBC) and the Commission on Cancer (COC) and less common for patients diagnosed at disproportionate share facilities (p&amp;lt;0.05 for all). After adjusting for age, stage at diagnosis, and tumor characteristics, the disparity in receipt of SLNB was 24 percentage points. In mediation analysis, facility accreditation and disproportionate share status explained 43% of the disparity (p=0.030). Conclusion: During the mid to late 2000s when the practice of SLNB as an alternative to ALND was reaching about half of eligible patients in Chicago, ethnic minority patients were less likely than their nL White counterparts to receive SLNB. Facility accreditation explained a substantial portion of this disparity. Better access and opportunities to go to highly accredited facilities may decrease this disparity. Citation Format: Bethliz Irizarry, Keith Dookeran, Garth Rauscher. Exploring disparities in sentinel lymph node biopsy within the Breast Cancer Care in Chicago study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C31.

The role of the American College of Surgeons' cancer program accreditation in influencing oncologic outcomes.

The multidisciplinary Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), administered by the American College of Surgeons (ACoS), defines evidence and consensus-based standards, require an operational infrastructure, collect high quality cancer data, and validate compliance with standards through external peer review. A survey of our constituents confirms a high level of agreement that accreditation is regarded as important in improving oncologic outcomes through compliance with standards that include continuous quality improvement.

The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center

A patient navigation process is required for accreditation by the National Accreditation Program for Breast Centers (NAPBC). Patient navigation has previously been shown to improve timely diagnosis in patients with breast cancer. This study sought to assess the effect of nurse navigation on timeliness of care following the diagnosis of breast cancer by comparing patients who were treated in a comprehensive cancer center with and without the assistance of nurse navigation. Navigation services were initiated at an NAPBC-accredited comprehensive breast center in July 2010. Two 9-month study intervals were chosen for comparison of timeliness of care: October 2009 through June 2010 and October 2010 through June 2011. All patients with breast cancer diagnosed in the cancer center with stage 0 to III disease during the 2 study periods were identified by retrospective cancer registry review. Time from diagnosis to initial oncology consultation was measured in business days, excluding holidays and weekends. Overall, 176 patients met inclusion criteria: 100 patients prior to and 76 patients following nurse navigation implementation. Nurse navigation was found to significantly shorten time to consultation for patients older than 60 years (B = -4.90, P = .0002). There was no change in timeliness for patients 31 to 60 years of age. Short-term analysis following navigation implementation showed decreased time to consultation for older patients, but not younger patients. Further studies are indicated to assess the long-term effects and durability of this quality improvement initiative.

The Challenge of Quality in Breast Care: Beyond Accreditation

The Challenge of Quality in Breast Care: Beyond Accreditation

P2-13-09: First Statewide Experience with Telephone Delivery of Cancer Genetic Counseling.

Abstract Background: National guidelines and multiple professional medical societies recommend genetic counseling as the standard of care for women with a personal and/or family history suggestive of a hereditary cancer syndrome. In addition, the ability to provide risk assessment and genetic counseling is a requirement for accreditation of breast centers by organizations such as the National Accreditation Program for Breast Centers (NAPBC) and the Commission on Cancer. However, there is clear evidence that this standard is not being achieved. Many individuals are undergoing genetic testing for these syndromes without adequate pre- and post-test counseling and, on the other hand, many individuals who are appropriate for genetic testing are not being identified and referred for genetic counseling and therefore not receiving potentially life-saving genetic information and services. A number of factors have been identified as contributors to these poor public health outcomes, including a lack of available genetic counseling services due to a limited number of trained genetics professionals and their limited geographic distribution. Research has demonstrated the effectiveness of cancer genetic counseling delivered by telephone, but to date, almost no real-world experience has been reported. We provided statewide access to board-certified genetic counselors via telephone in Michigan beginning in February 2010 and report our experience with the first 200 patients at risk for hereditary breast and ovarian cancer. Materials and Methods: Baseline data were analyzed for all Michigan patients undergoing telephone genetic counseling through Informed Medical Decisions since service delivery began in February 2010. Variables include demographics, geographic location, personal cancer history, family cancer history, Gail risk and test appropriateness criteria. Results: Analysis has been completed on the first 200 patients referred for consideration of hereditary breast and ovarian cancer. Outcomes include testing, results and, where applicable, reasons testing was not pursued, patient and provider satisfaction, as well as trends over time in patient volumes, providers using the service and uptake by geographic location. Conclusion: Based on statewide experience in Michigan, telephone cancer genetic counseling is a viable method for service delivery in the real world. The Michigan experience can serve as a cost-effective model for improving genetic services in other locations with limited access to genetic experts. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-13-09.