The quality issues in the diagnosis and treatment of breast cancer in Taiwan
Objectives: The objectives of this study were two-fold, Using the guidelines based on evidence, we analyzed the patterns of diagnosis and treatment of breast cancer in Taiwan. The second objective was to determine whether the data generated from the analysis could be adopted for assuring quality of care in breast cancer. Methods: We used the claims data of the Bureau of National Health Insurance (BNHI) from hospitals throughout Taiwan between January 1997 and November 1999 for a secondary data analysis, The patterns of diagnosis and treatment were divided into three stages, namely diagnosis, treatment, and follow-up conducted in hospitals whenever mastectomy was performed for the new cases of breast cancer recorded in 1997. The analysis was then made on the differences in the pattern of diagnosis and treatment amongst hospitals in Taiwan, Ultimately, a comparison was made against various quality indicators developed for breast cancer. Results: (1) In the diagnostic area, the rate of cytologic and histologic diagnosis as well as blood tests reached 97%. However this figure was not reached for the ER/PR receptor examination and breast sonography or mammography. (2) More than 60% of the patients with noninvasive carcinomas were still treated with modified radical mastectomy. This study also showed an unexpected low rate of radiation therapy after breast conservation surgery in most hospitals. (3) Medical centers and regional hospitals were consistent in their use of the chemotherapy regimen according to accepted practice guidelines, whereas the inconsistency rates among district hospitals were greater than 60%. (4) In the follow-up period, the breast sonography or mammography was less often ordered (50%) than what the standard required. (5) The rate of examination for ER/PR receptor status before and after initiation of hormonal treatment were low, and the variation among hospitals was also large, Conclusions: Breast cancer claims data of BNHI can be used to determine the quality of care with reasonable accuracy, Our analysis of breast cancer indicated that while certain tests or treatments were consistent with good practice of oncology based on evidences accepted worldwide, some important tests and treatments were carried out at frequencies significantly lower than what was considered to be acceptable. The only significant deficiency in the claims data for analysis of quality standards is the lack of staging information for breast cancer or any other cancer, We urge that such information be added as a requirement for the filing of reimbursement claims by the hospital which treats cancer patients.
Lin, HC; Yeh, LL; Wu, JY; Huang, AT
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