Breast cancer quality of care in Taiwan in relation to hospital volume: a population-based cohort study

Fu Ou-Yang; Nicholas C Hsu; Chiung-Hui Juan; Hsin-I Huang; Sin-Hua Moi; Fang-Ming Chen; Tsang-Wu Liu; Ming-Feng Hou

doi:10.1111/ajco.12403

Breast cancer quality of care in Taiwan in relation to hospital volume: a population-based cohort study

Asia Pac J Clin Oncol. 2015 Dec;11(4):308-13. doi: 10.1111/ajco.12403. Epub 2015 Aug 12.

Authors

Fu Ou-Yang^{1

2}, Nicholas C Hsu³, Chiung-Hui Juan⁴, Hsin-I Huang⁵, Sin-Hua Moi⁵, Fang-Ming Chen^{1

6}, Tsang-Wu Liu⁷, Ming-Feng Hou^{1

3

6

8}

Affiliations

¹ Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁷ National Health Research Institutes, Miaoli, Taiwan.
⁸ National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung, Taiwan.

PMID: 26264379
DOI: 10.1111/ajco.12403

Abstract

Aim: To evaluate, compare and improve quality of care for patients with breast cancer at the institution and population level requires a standard set of core measures. We performed a population-based cohort study to examine the association between hospital volume and breast cancer core measures compliance in Taiwan.

Methods: Data were obtained from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. All women with a diagnosis of breast cancer between 2007 and 2011 were selected. Hospitals were divided into quartiles of hospital volume based on the total number of breast cancer surgery performed from 2007 to 2011. The core measure set that evaluates the quality of care for breast cancer included one preoperation and nine treatment-related indicators.

Results: Our final study population included 38 943 patients from 74 hospitals. An increase in hospital volume was associated with better core measures compliance as indicated by higher adherence rates. As compared with the lower quartiles (quartiles 1/2/3) of hospital volume, quartile 4 (high volume) showed significantly higher adherence rate in two indicators measured ("percentage of breast cancer patients whose diagnoses were histologically and cytologically confirmed before surgery" and "percentage of stage 1 and 2 patients with sentinel node sampling performed," P = 0.011 and 0.016, respectively). An increasing trend in compliance for "percentage of stage 1 patients who underwent breast conserving surgery" was observed in high-volume but not low-volume hospitals (P < 0.001).

Conclusion: This institution and population-based study showed a certain degree of variation to core measures compliance among hospitals. In some aspects of pre- and postoperative care, high-volume hospitals demonstrated higher and more improved quality as supported by increased adherence rates. Further research is needed to determine whether better core measures compliance would result in better outcomes.

Keywords: breast cancer; core measure; hospital volume; medical center.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms / epidemiology
Breast Neoplasms / therapy*
Carcinoma, Ductal, Breast / epidemiology
Carcinoma, Ductal, Breast / therapy*
Combined Modality Therapy
Female
Hospitals / standards*
Humans
Longitudinal Studies
Middle Aged
Neoplasm Grading
Neoplasm Staging
Outcome Assessment, Health Care*
Prognosis
Quality of Health Care*
Registries
Taiwan / epidemiology