Abstract
Background/Aims Surgical quality is typically measured using 30-day morbidity and mortality statistics – measures that are not very meaningful for procedures such as lumpectomies and mastectomies that have extremely high survival rates. The University of Vermont previously developed a single-site Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful quality measures such as breast conservation rates, positive margins rates, and number of procedures to complete breast cancer surgery. We extended the BRCASO database to three Cancer Research Network (CRN) institutions to study variation in breast cancer surgical quality across providers, facilities, and health plans.
Methods The University of Vermont BRCASO data were collected on women diagnosed with breast cancer between 2003–2008 via medical record abstraction. In order to efficiently extend this work to CRN institutions, we collected electronic administrative data from each health plan (Group Health, Kaiser Permanente Colorado, and Marshfield Clinic) on women diagnosed with breast cancer between 2003–2008. Electronic administrative data included tumor registry information, Current Procedure Terminology codes for all breast cancer surgeries, study IDs for surgeons and surgical facilities, and demographic information including geocoded data. We supplemented the electronic administrative data with medical record abstraction to collect detailed information on surgical margins and lymph nodes. All medical record data were entered into a secure, online database developed using Silverlight.
Results Using electronic administrative data, we determined 5,673 women met the study inclusion criteria. The CRN institutions pre-filled 30% (22 out of 72) of elements using electronic data. The remaining 50 elements required chart abstraction, which took approximately 45–60 minutes per record.
Conclusions Electronic administrative data, while useful for research, have limitations and may not suit the needs of all studies. In our study, using electronic administrative data substantially decreased the amount of chart abstraction required at the CRN institutions; however, was not exclusively sufficient for all abstraction. Although manual abstraction was necessary for high quality data, the use of an electronic system greatly facilitated this effort and helped expand the BRCASO database to become the only multi-site source of detailed surgical quality information in the country.
