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Showing content from https://pubmed.ncbi.nlm.nih.gov/19033569/ below:

A tracking and feedback registry to reduce racial disparities in breast cancer care

Comparative Study

. 2008 Dec 3;100(23):1717-23. doi: 10.1093/jnci/djn387. Epub 2008 Nov 25. A tracking and feedback registry to reduce racial disparities in breast cancer care

Affiliations

Affiliation

¹ Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA. nina.bickell@mssm.edu

PMID: 19033569
PMCID: PMC2727139
DOI: 10.1093/jnci/djn387

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Comparative Study

A tracking and feedback registry to reduce racial disparities in breast cancer care

Nina A Bickell et al. J Natl Cancer Inst. 2008.

. 2008 Dec 3;100(23):1717-23. doi: 10.1093/jnci/djn387. Epub 2008 Nov 25. Affiliation

¹ Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA. nina.bickell@mssm.edu

PMID: 19033569
PMCID: PMC2727139
DOI: 10.1093/jnci/djn387

Item in Clipboard

Abstract

Background: Black and Hispanic women with early-stage breast cancer are more likely than white women to experience fragmented care and less likely to see medical oncologists to get effective adjuvant treatment. We implemented a tracking and feedback registry to close the referral loop between surgeons and oncologists.

Methods: We compared completed oncology consultations and use of adjuvant treatment among a group of 639 women with newly diagnosed stage I or II breast cancer who had undergone surgery at one of six New York City hospitals from 1999 to 2000 with the same outcomes for a different group of 300 women with breast cancer whose surgeries occurred in 2004-2006, after the implementation of the tracking registry. Underuse of adjuvant treatment was defined as no radiotherapy after breast-conserving surgery, no chemotherapy for estrogen receptor (ER)-negative tumors, or no hormonal therapy for ER-positive tumors 1 cm or larger. We used hierarchical modeling to adjust for clustering within hospital and surgeon practice. Odds ratios were converted to adjusted relative risks (aRRs). All statistical tests were two-sided.

Results: Implementation of the tracking and feedback registry was accompanied by a statistically significant increase in oncology consultations (83% before vs 97% after the intervention; difference = 14%; 95% confidence interval [CI] = 11% to 18%; P < .001) and decrease in underuse of adjuvant treatment (23% before vs 14% after the intervention; difference = -9%, 95% CI = -12% to -6%; P < .001). Underuse declined from 34% to 14% among black women, from 23% to 13% among Hispanic women, and from 17% to 14% among white women (chi-square of change in underuse from before to after among the three racial groups; P = .001). In multivariable models adjusting for clustering by hospital and surgeon, the intervention was associated with increased rates of oncology consultation (aRR = 1.6, 95% CI = 1.3 to 1.8), and reduced underuse of adjuvant treatment (aRR = 0.75, 95% CI = 0.6 to 0.9). Compared with the preintervention findings, minority race was no longer a risk factor for low rates of oncology consultation (aRR = 1.0, 95% CI = 0.7 to 1.3) or for underuse of adjuvant therapy (aRR = 1.0, 95% CI = 0.8 to 1.3).

Conclusions: A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment.

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