I recently attended the Pursuing Excellence through Accreditation Workshop in Chicago. The National Accreditation Program for Breast Centers hosted a well-run and informative event, focused on breast centers and why NAPBC accreditation matters.
The event began with a presentation focusing on “Why Accreditation Matters.” Although I did find this presentation to be helpful, by this point, I think we are all sold on the idea that breast centers should follow some set of quality and operational standards. In fact, although the vast majority of states have accredited breast centers, I was surprised to find out that there is yet to be an accredited facility in Arizona.
Scott H. Kurtzman MD, FACS, gave a terrific presentation, “Understanding Key Components and Standards,” referring to the set of NAPBC reportable items that are reviewed when a center undergoes accreditation. His jocular presentation style was engaging and invited questions. Dr. Kurtzman’s detailed review of each reportable measure was extremely helpful. I found the discussion surrounding breast conservation surgery versus mastectomy to be particularly interesting to me. As a non-clinician, I am able to see the benefits of removing only some of the breast tissue, rather than the whole breast. I think of benefits in recovery time, cost, cosmetics, complications, etc.
Some of the clinicians in the audience were focused on only one (perhaps the most important) aspect of the outcome – recurrence or the surgery’s ability to treat the cancer. Why is breast conservation surgery less acceptable if that single outcome is the same or perhaps, in the opinion of some, better? Dr. Kurtzman acknowledged that this is a hot button issue and that the 50% case mix of breast conservation surgery versus mastectomy may sound arbitrary. We were reminded that this NAPBC requirement (2.3) is seldom an issue for breast centers. Also, the denominator needs to be only the analytic cases (diagnosed and treated within your facility) you see in your breast center. The denominator MUST include all analytic cases even if lumpectomy was not an option (whether patient or physician driven). We cannot exclude patients choosing a mastectomy when a lumpectomy was an option, but they just felt better about a mastectomy.
Data management is one of the most difficult issues in accreditation. One of the main reasons Oncology OnTrack exists is to help cancer centers manage this data – ALL OF IT. My reason for attending the event was to discover how Priority Consult can better help its Oncology OnTrack clients gather, review and report ALL NAPBC indicators that can be quantified. Other factors in data management, such as whether or not the breast program has a leadership board that can actually make changes and if they meet regularly, are up to each individual cancer center. We would love to report that for you, but your NAPBC site auditor is going to want to see minutes from meetings and talk to those on the leadership team to see if in fact you are all on the same page.
Please contact us if you would like to learn more about how Oncology OnTrack can help with navigation and manage all of your NAPBC data.