Research article

Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results (2003–2007) from Germany as a proof of concept

Sara Y Brucker¹ , Claudia Schumacher² , Christoph Sohn³ , Mahdi Rezai⁴ , Michael Bamberg⁵ , Diethelm Wallwiener¹ and the Steering Committee⁶

¹  Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany

²  St. Elisabeth-Krankenhaus Köln-Hohenlind, Cologne, Germany

³  Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg, Germany

⁴  Brustzentrum Düsseldorf im Luisenkrankenhaus, Düsseldorf, Germany

⁵  Department of Radiooncology, University of Tübingen, Tübingen, Germany

⁶  For full list, see Acknowledgements

author email corresponding author email

BMC Cancer 2008, 8:358doi:10.1186/1471-2407-8-358

Published:	2 December 2008

Abstract

Background

The main study objectives were: to establish a nationwide voluntary collaborative network of breast centres with independent data analysis; to define suitable quality indicators (QIs) for benchmarking the quality of breast cancer (BC) care; to demonstrate existing differences in BC care quality; and to show that BC care quality improved with benchmarking from 2003 to 2007.

Methods

BC centres participated voluntarily in a scientific benchmarking procedure. A generic XML-based data set was developed and used for data collection. Nine guideline-based quality targets serving as rate-based QIs were initially defined, reviewed annually and modified or expanded accordingly. QI changes over time were analysed descriptively.

Results

During 2003–2007, respective increases in participating breast centres and postoperatively confirmed BCs were from 59 to 220 and from 5,994 to 31,656 (> 60% of new BCs/year in Germany). Starting from 9 process QIs, 12 QIs were developed by 2007 as surrogates for long-term outcome. Results for most QIs increased. From 2003 to 2007, the most notable increases seen were for preoperative histological confirmation of diagnosis (58% (in 2003) to 88% (in 2007)), appropriate endocrine therapy in hormone receptor-positive patients (27 to 93%), appropriate radiotherapy after breast-conserving therapy (20 to 79%) and appropriate radiotherapy after mastectomy (8 to 65%).

Conclusion

Nationwide external benchmarking of BC care is feasible and successful. The benchmarking system described allows both comparisons among participating institutions as well as the tracking of changes in average quality of care over time for the network as a whole. Marked QI increases indicate improved quality of BC care.