Elsevier

The Breast

Volume 23, Issue 4, August 2014, Pages 364-370
The Breast

Original article
Quality improvement by implementing an integrated oncological care pathway for breast cancer patients

https://doi.org/10.1016/j.breast.2014.01.008Get rights and content
Under a Creative Commons license
open access

Abstract

Background and aim

In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer pathway in three hospitals has improved the care for breast cancer patients.

Methods

Retrospectively almost 800 patients with breast cancer were selected from the Netherlands Cancer Registry (NCR). The patients were divided in two groups: before implementation of the pathway in 2006–07 (baseline measurement) and those after implementation in 2009 (post measurement). Fourteen quality indicators were compared before and after the implementation of the care pathway. To estimate the impact of the care pathway relative to evidence based guidelines and profession-based norms, involved project leaders were interviewed.

Results

Seven out of eight indicators with medical information and four out of five indicators with information about waiting- and throughput times improved. With the multidisciplinary meeting as key in the breast cancer care, more compliance to national guidelines was observed. E.g. for more patients a HER2neu test was performed after implementation of the pathway (from 92% to 96%,  = 0.016) and more patients started with their first chemotherapy (from 33% to 45%) or their first radiotherapy (from 55% to 59%) within 4 weeks after surgery.

Conclusion

Implementing a multidisciplinary breast cancer pathway leads to better compliance with the national guidelines and can improve breast cancer care.

Keywords

Care pathways
Multidisciplinary cancer care
Integrated healthcare systems
Breast cancer

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