BUFFALO, NYOne use of cancer practice guidelines will be to
raise the standard of care in a community and create partnerships
between cancer centers and payers, Stephen Edge, MD, told the
Presidents Cancer Panel.
Dr. Edge, chief of Breast Surgery at Roswell Park, described a
collaborative effort among Roswell Park; Independent Health, Inc. (a
not-for-profit HMO in Western New York); and a panel of community
physicians to examine the quality of breast cancer care in the
region, using administrative claims data from Independent Health, and
explore ways to improve current practices.
We hypothesized that claims data would show a cross section of
breast cancer care in Western New York. We wanted to determine
patterns of care to evaluate quality, including comparison of care in
the region with the established practice guidelines of the National
Comprehensive Cancer Network, Dr. Edge said.
Patients were identified from claims data of breast procedures and
diagnoses over a 2-year period from 1995 to 1997, plus 6 months of
subsequent insurance claims. The type of care was determined from the
claims. Cancer stage was determined by obtaining surgery and
pathology reports through the HMO.
One area of quality evaluation was the rate of positive findings on
mammo-graphic-directed breast biopsy. The study showed 2,798
biopsies2,376 patients with no cancer and 422 with a confirmed
cancer diagnosis. In the optimal practice setting, 25% to 30% of
these biopsies should be positive for cancer. Claims data
demonstrated that in Western New York, about 18% of
mammographic-directed biopsies were positive. However, the rate of
positive biopsy varied significantly among individual radiologists
and surgeons, ranging from 7% to 39%.
Other measures of quality care under study include the rate of
breast-conserving surgery (about 60%)and the number of second breast
surgeries to re-excise additional tissue due to positive margins.
Optimally, our goal is to have only one surgical procedure on a
breast to remove malignancy. If we could eliminate some of these
secondary surgeries, we could save a great deal of money and anxiety
in this population, Dr. Edge said.
Overall, the study has shown the feasibility of studying practice
patterns in breast cancer using claims data, and the potential
applicability of the method to other cancers. The next step, he said,
is to complete the review of data and comparison with NCCN
guidelines. Feedback of these results to providers should assist in
ongoing quality improvement.