What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand?

AIM: To evaluate BreastSurgANZ members' compliance at various threshold rates for 4 evaluable High-Quality Performance Indicators (HQPIs) introduced to improve patient care. To benchmark global best practice to assist in determining the eventual threshold standards. METHOD: BreastSurgANZ Quality Audit data 2012-2016 & 2018 was used to determine rates of attainment through a range of thresholds for 4 HQPI's. Rates were assessed for different volume surgeons and comparison made to international standards. RESULTS: 1.3761 patients needing mastectomy for in situ disease, if the threshold rate for immediate breast reconstruction (IBR) was ≥ 40% then 30% of all members and 78% of very high-volume surgeons achieved that rate, which is comparable to international recommendations. 2.26,007 patients requiring mastectomy, if the threshold rate for IBR was ≥ 20% then 28% of all surgeons and 78% very high-volume surgeons met the standard. This is below most international recommendations. 3. For 31,698 invasive tumours ≤ 2 cm, if the threshold rate for breast conservation was ≥ 70% then 64% of all surgeons met the standard; 70% is comparable internationally. 4.1382 women =<50 years if the threshold rate for neoadjuvant chemotherapy was set at ≥ 15% then 36% of surgeons complied; 15% is below most international recommendations. CONCLUSIONS: Even at these modest thresholds there are low levels of achievement by BreastSurgANZ members with high volume surgeons more likely to comply. These thresholds are either comparable or lower than globally accepted standards. Members should strive to meet, even exceed these important goals as they are a metric of improved patient care.

Operating principles for running a clinical quality registry: are they feasible?

BACKGROUND: The National Breast Cancer Audit (NBCA) was one of six national registries selected by open tender to test and validate the draft Operating Principles and Technical Standards for Australian Clinical Quality Registries. The standardization proposed by the Australian Commission on Safety and Quality in Health Care through this initiative sought to improve the overall efficiency and function of registries, as well as compatibility between registries. The NBCA's role involved testing, and implementing where possible, the proposed principles and standards in the NBCA environment so as to validate them in an operating registry. METHODS: The forty-two draft operating principles were evaluated by the NBCA based on four factors: relevance to the audit, feasibility of implementation by the audit, extent of difficulty in implementation and extent of improvement. An evaluation of the technical standards was also conducted. RESULTS: At the completion of the project, the audit met 27 of the 42 draft principles with only three principles marked as entirely unfeasible or not relevant to the NBCA. The remaining principles were either in the process of being implemented, implemented in part or awaiting discussion through governance channels. CONCLUSION: A revised principles and standards document has been produced. This will have a significant impact on quality of care in Australia as more audits and registries use it as a guide. Changes implemented at the NBCA have enhanced the audit as a tool for improving the quality of care received by early breast cancer patients.