In April 2007, the National Quality Forum (NQF) endorsed the first nationally recognized hospital-based performance measures for quality of care for breast cancer. The aim of this study was to measure quality of care at our AVON Center for Breast Care (AVONCBC) using these indicators. We retrospectively reviewed tumor registry and medical records of females under age 70 diagnosed with breast cancer in years 2005-2006. For patients diagnosed with hormone receptor negative breast cancer, 22 of 29 (75.9%) and 28 of 32 (87.5%) were considered for or received chemotherapy in 2005 and 2006, respectively. Of those patients, 21 of 29 (72.4%) and 24 of 32 (75.0%) were considered for or received chemotherapy within the NQF 4-month period. For patients undergoing breast conserving surgery (BCS), 20 of 23 (86.9%) in 2005 and 37 of 39 (94.9%) in 2006 were referred for adjuvant radiation therapy. The proportion of patients who received radiation therapy within 1 year of diagnosis was 18 of 23 (78.2%) and 29 of 39 (74.4%) for diagnosis years 2005 and 2006, respectively. The vast majority of patients in our AVONCBC are referred to medical and/or radiation oncology for adjunctive therapy and about three-fourths receive treatment compliant with the NQF QI. To increase our compliance rate, we are developing methods to improve access to the multiple disciplines in our AVONCBC. Using the NQF indicators serves to assess hospital performance at a systems-level and as a useful method for tracking cancer quality of care.

The Georgia Comprehensive Sickle Cell Center at Grady Memorial Hospital was established in 1985 to provide primary care and 24 hour acute care to patients with sickle cell syndromes with the goals of providing better patient care. The Center is equipped with an acute care center with 12 observation beds, a clinic area with 6 exam rooms, a waiting room, a multimedia teaching center for patients, and support offices. The initial experience showed very high outpatient and inpatient utilization by a small number of patients. In 1990, to address this problem, a comprehensive care program was instituted. The multidisciplinary care management program involving physicians, nurses, physician assistants, nurse practitioners, clinic assistants, social workers, psychologists, secretarial support and a psychiatric clinical nurse specialist addresses patients’ medical, social, psychological and vocational needs. Outcome analysis of the impact of this program is based on demographics, disease-specific characteristics, outpatient visit frequency, and admission data contained in a clinical database. This analysis shows that the program significantly reduced acute care visits and hospital admissions. In the five year period from 1985–1989, prior to the multidisciplinary program, there were 1152 acute care visits per 100 patients/year and 137 admissions per 100 patients/year. In the five year period following institution of the multidisciplinary management program, acute care visits were reduced to 355 acute care visits per 100 patients/year and 61 hospital admissions per 100 patients/year. These results were durable for the next decade (Table 1). Major factors in this reduction were departure of 24 patients with greater than 52 visits a year and a similar reduction in acute visits and hospitalizations in 166 patients that continued as active patients. A care facility dedicated to acute and ongoing management of patients with sickle cell syndromes is necessary, but not sufficient to improve their health outcomes. A multidisciplinary care program that addresses the medical, social and psychological needs of these patients is required to reduce health care utilization. In conclusion, this data demonstrates a dramatic decrease in hospital health resource utilization with the establishment of a multidisciplinary care management approach in a disease-specific comprehensive center. This model is effective for sickle cell syndromes; a chronic disease characterized by acute exacerbations, and could be considered in other similar diseases such as asthma, diabetes, and chest pain. Table 1. Georgia Comprehensive Sickle Cell Center - Clinical Activity 1985–1989 1990–1994 1995–1999 2000–2004 *Active patient = one or more visits every two years. **Mean ± SD Average active adult Pt/year* 414 ± 52** 545 ± 85 648 ± 125 1055 ± 113 Average F/U clinic appts/year 1362 ± 26 1879 ± 58 2128 ± 134 3190 ± 313 Acute care visits 100 Pt/years 1152 ± 129 355 ± 92 371 ± 36 348 ± 64 Admissions/100 Pt years 137 ± 19 61 ± 15 72 ± 11 53 ± 6