Improving breast cancer care through a regional quality collaborative

Breslin, Tara M.; Caughran, Jamie L.; Pettinga, Jane; Wesen, Cheryl; Mehringer, Ann M.; Yin, Huiying; Share, David; Silver, Samuel

doi:10.1016/j.surg.2011.07.071

Cited by 25 publications

(18 citation statements)

References 16 publications

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“…Other population-studies have focused on breast cancer patients exclusively, and therefore lack the true denominator of all breast biopsies. 10,19,21,22 These studies demonstrate slightly higher biopsy rates, ranging from 61% to 87%. The slightly higher reported rates in these studies are consistent with our observation that patients with an ultimate diagnosis of breast cancer were more likely to get MIBB.…”

Section: Discussionmentioning

confidence: 82%

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Time Trends and Geographic Variation in Use of Minimally Invasive Breast Biopsy

Zimmermann

Sheffield

Duncan

et al. 2013

Journal of the American College of Surgeons

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Background Current guidelines recommend minimally invasive breast biopsy (MIBB) as the “gold standard” for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas. Methods We used 100% Texas Medicare claims data (2000–2008) to identify women ≥66 years who underwent breast biopsy. Biopsies were classified as open or minimally invasive (MIBB). Time trends, racial/ethnic variation, and geographic variation in the use of biopsy techniques were examined. Results A total of 87,165 breast biopsies were performed on 75,518 breast masses in 67,582 women. 65.8% of the initial biopsies were MIBB. Radiologists performed 70.3% and surgeons 26.2% of MIBB. Surgeons performed 94.2% of open biopsies. Hispanic women were less likely to undergo MIBB (55.9%) compared to white (66.6%) and black (68.9%) women (p<0.0001). Women undergoing MIBB were also more likely to live in metropolitan areas and have higher income and educational levels (p<0.0001). The rate of MIBB increased from 44.4% in 2001 to 79.1% in 2008 (p<0.0001). There are clear geographic patterns in MIBB use with highest use near major cities. While rates are increasing overall, rates of improvement in the use of MIBB vary significantly across geographic regions and remain persistently low in more rural areas. Conclusion Despite an increase in the use of MIBB over time, MIBB use was consistently lower than recommended. We must identify specific barriers in rural areas to effectively change practice and achieve the statewide goal of 90% MIBB.

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Section: Discussionmentioning

confidence: 82%

“…Our hypothesis was that MIBB would be similarly underutilized in Texas, as reported in other population-based studies. 6,10,19,21,22 Our goal was to better understand the geographic, racial/ethnic, and socioeconomic patterns and trends in use of MIBB in order to determine barriers to achieving the goal of >90% MIBB rates.…”

Section: Introductionmentioning

confidence: 99%

Time Trends and Geographic Variation in Use of Minimally Invasive Breast Biopsy

Zimmermann

Sheffield

Duncan

et al. 2013

Journal of the American College of Surgeons

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“…The development of collaborative clinical networks in other rare or complex conditions has assisted in disease diagnosis and classification, 19 development of investigation and management algorithms 20 and facilitates collection, analysis and dissemination of data. 21 The North American Fetal Therapy Network (NAFTNet) has called for collaboration to establish a national agenda for clinical and research progress in the area of fetal therapy, 22 recognising the strengths of academic and clinical partnerships in studying rare conditions and interventions, of which FLP for TTTS is one.…”

Section: Discussionmentioning

confidence: 99%

‘A problem shared is a problem halved’: success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin–twin transfusion syndrome in Victoria

Teoh

Walker

Cole

et al. 2013

Aust NZ J Obst Gynaeco

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These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in Victoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow-up of patients and to optimise training and research opportunities.

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“…The development of collaborative clinical networks in rare or complex conditions has assisted in disease diagnosis and classification (Mehta et al, 2007) and the development of investigation and management algorithms (Samra et al, 2011), and facilitates collection, analysis and dissemination of data (Breslin et al, 2011). Regardless of the membership, the principles of collaborative services remain much the same.…”

Section: Multicenter Collaborative Service Modelsmentioning

confidence: 99%

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

et al. 2016

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The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.

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Improving breast cancer care through a regional quality collaborative

Cited by 25 publications

References 16 publications

Time Trends and Geographic Variation in Use of Minimally Invasive Breast Biopsy

Time Trends and Geographic Variation in Use of Minimally Invasive Breast Biopsy

‘A problem shared is a problem halved’: success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin–twin transfusion syndrome in Victoria

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

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