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  • Measure Summary
  • NQMC:011217
  • Jul 2016

Breast cancer: proportion of patients with breast cancer who undergo immediate breast reconstruction at the time of mastectomy.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Clinical Quality Measure: Access

Description

This measure is used to assess the proportion of patients with breast cancer who undergo immediate breast reconstruction at the time of mastectomy.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Evidence suggests that breast reconstruction is not associated with an increase in the rate of local recurrence, nor does it affect the ability to detect recurrence, and it can yield psychological benefit. There may be good reasons for individual patients not to undergo immediate breast reconstruction but this indicator is intended to demonstrate that mastectomy patients have access to a reconstructive service (Scottish Intercollegiate Guidelines Network [SIGN], 2005; NHS Cancer Screening Programmes, 2009).

Access to immediate breast reconstruction is very difficult to measure accurately; therefore uptake is utilised within this Cancer Quality Performance Indicator (QPI) as a proxy for access. Although it will not provide an absolute measure of patient access to this procedure it will give an indication of access across NHS Boards and highlight any areas of variance which can then be further examined.

Evidence for Rationale

NHS Cancer Screening Programmes. Quality assurance guidelines for surgeons in breast cancer screening. Sheffield (UK): NHS Cancer Screening Programmes; 2009 Mar. 36 p.  (NHSBSP publication; no. 20). [17 references]

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Scottish Intercollegiate Guidelines Network (SIGN). Management of breast cancer in women. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2005 Dec. 50 p. (SIGN publication; no. 84).  [214 references]

Primary Health Components

Breast cancer; mastectomy; breast reconstruction

Denominator Description

All patients with breast cancer undergoing mastectomy (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with breast cancer undergoing immediate breast reconstruction at the time of mastectomy (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Monitoring and planning

National reporting

Public reporting

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with breast cancer undergoing mastectomy

Exclusions

  • All patients with M1 disease*
  • All male patients

*The exclusion of patients with M1 disease is not intended to imply that mastectomy and immediate reconstruction is not a valid treatment option for patients with metastatic disease. The development group recommend that all patients are discussed on an individual basis to determine the most appropriate treatment.

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients with breast cancer undergoing immediate breast reconstruction at the time of mastectomy

Exclusions

  • All patients with M1 disease*
  • All male patients

*The exclusion of patients with M1 disease is not intended to imply that mastectomy and immediate reconstruction is not a valid treatment option for patients with metastatic disease. The development group recommend that all patients are discussed on an individual basis to determine the most appropriate treatment.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 25%

The tolerance within this target accounts for patient choice and fitness for treatment. Patient choice is a key factor in the number of patients who undergo immediate breast reconstruction at the time of mastectomy.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Original Title

QPI 5 – immediate reconstruction rate.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Breast Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Breast Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jul

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on June 7, 2017.

Copyright Statement

No copyright restrictions apply.

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