360 Health Analysis (H360) – A comparison of key performance indicators in breast cancer management across health institution settings

Background: The increased focus on quality indicators (QIs) and the use of clinical registries in real-world cancer studies have led to higher compliance with therapeutic standards and increased patient survival. The European Society of Breast Cancer Specialists (EUSOMA) defined QIs to assess compliance with current standards in breast cancer care. Methods This population-based retrospective study is part of the H360 Health Analysis (H360) project - Phase 2 and represents the first comprehensive assessment of the quality of breast cancer care in different hospital settings in Portugal. Its aim is to describe compliance with EUSOMA-defined QIs in breast cancer management in different hospital settings (public vs. private; general hospitals vs. Oncology centers) and thereby assess equity in the provision of care across health institutions. To do so, a set of key performance indicators (KPIs) was selected based on EUSOMA and previously identified QIs. Secondary data were retrieved from patients’ clinical records. Compliance with target KPIs in different stages of disease across the considered hospital settings was compared with minimum and target EUSOMA standards. Results A total of 259 patient clinical records were assessed. In stage I, II, and III disease, eighteen KPIs met target EUSOMA standards, five met minimum standards, and eight failed to meet minimum standards. Compliance with KPIs varied according to the type of hospital (particularly concerning diagnosis) and stage of the disease. Conclusions Study results show that, although most QIs meet EUSOMA standards, there is room for improvement regarding diagnostic and therapeutic procedures. There are differences in the clinical practice across health institutions, particularly between Oncology centers and general hospitals regarding diagnosis and KPI compliance among disease stages. These findings should be addressed in future studies in a coordinated effort to improve the quality of breast cancer care nationally.