Beyond the Mammography Quality Standards Act: Measuring the Quality of Breast Cancer Screening Programs
Beyond the Mammography Quality Standards Act: Measuring the Quality of Breast Cancer Screening Programs
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DOI：
10.2214/ajr.13.10806
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发表时间：
2014-01-01
影响因子：
5
通讯作者：
Weldon, Christine B.
中科院分区：
文献类型：
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作者：
Rauscher, Garth H.;Murphy, Anne Marie;Weldon, Christine B.
OBJECTIVE.一个高质量的筛查乳腺X线摄影计划应该发现乳腺癌时，它的存在和当病变很小，并确保可疑的结果得到及时的后续行动。乳腺X线摄影质量标准法案（MQSA）与跟踪结果相关的指南不足以评估护理质量。我们使用质量改进项目的数据来确定筛查乳腺X射线摄影设施是否可以显示它们满足MQSA所要求的质量基准。材料和方法。参与机构提供了2009日历年进行的筛查性乳房X线摄影检查和相应的诊断随访的汇总数据，包括失访患者、诊断成像和活检的时间、癌症检出率以及检出为微小和早期肿瘤的癌症病例比例。在52间参与院校中，符合每项基准的院校所占百分比由27%至83%不等。与美国外科医生学会或乳腺中心指定的国家联盟的设施更有可能达到有关癌症检测和早期发现的基准，不成比例的共享设施不太可能达到有关及时护理的基准。结果表明，护理质量问题和对患者的不完整跟踪相结合。为了准确衡量乳腺癌筛查过程的质量，对筛查乳腺X线摄影结果异常的患者进行完整跟踪至关重要，以便仅从护理质量的角度解释结果。应加强MQSA跟踪结果和衡量质量指标的指导方针，以更好地评估护理质量。
OBJECTIVE. A high-quality screening mammography program should find breast cancer when it exists and when the lesion is small and ensure that suspicious findings receive prompt follow-up. The Mammography Quality Standards Act (MQSA) guidelines related to tracking outcomes are insufficient for assessing quality of care. We used data from a quality improvement project to determine whether screening mammography facilities could show that they met certain quality benchmarks beyond those required by MQSA.MATERIALS AND METHODS. Participating facilities provided aggregate data on screening mammography examinations performed in calendar year 2009 and corresponding diagnostic follow-up, including patients lost to follow-up, timing of diagnostic imaging and biopsy, cancer detection rates, and the proportion of cases of cancer detected as minimal and early-stage tumors.RESULTS. Among the 52 participating institutions, the percentage of institutions meeting each benchmark varied from 27% to 83%. Facilities with American College of Surgeons or National Consortium of Breast Centers designation were more likely to meet benchmarks pertaining to cancer detection and early detection, and disproportionate share facilities were less likely to meet benchmarks pertaining to timeliness of care.CONCLUSION. The results suggest a combination of quality of care issues and incomplete tracking of patients. To accurately measure the quality of the breast cancer screening process, it is critical that there be complete tracking of patients with abnormal screening mammography findings so that results can be interpreted solely in terms of quality of care. The MQSA guidelines for tracking outcomes and measuring quality indicators should be strengthened for better assessment of quality of care.