• Jessica R Schumacher, Elise H Lawson, Amanda L Kong, Joseph J Weber, Jeanette May, Jeffrey Landercasper, Bret Hanlon, Nicholas Marka, Manasa Venkatesh, Randi S Cartmill, Pavuluri QuammeSudhaSDepartment of Surgery, University of Wisconsin-Madison, Madison, WI., Connor Nikolay, and Caprice C Greenberg.
• Department of Surgery, University of Wisconsin-Madison, Madison, WI.
• Ann. Surg. 2022 Oct 1; 276 (4): 665672665-672.

ObjectiveTest the effectiveness of benchmarked performance reports based on existing discharge data paired with a statewide intervention to implement evidence-based strategies on breast re-excision rates.BackgroundBreast-conserving surgery (BCS) is a common breast cancer surgery performed in a range of hospital settings. Studies have demonstrated variations in post-BCS re-excision rates, identifying it as a high-value improvement target.MethodsWisconsin Hospital Association discharge data (2017-2019) were used to compare 60-day re-excision rates following BCS for breast cancer. The analysis estimated the difference in the average change preintervention to postintervention between Surgical Collaborative of Wisconsin (SCW) and nonparticipating hospitals using a logistic mixed-effects model with repeated measures, adjusting for age, payer, and hospital volume, including hospitals as random effects. The intervention included 5 collaborative meetings in 2018 to 2019 where surgeon champions shared guideline updates, best practices/challenges, and facilitated action planning. Confidential benchmarked performance reports were provided.ResultsIn 2017, there were 3692 breast procedures in SCW and 1279 in nonparticipating hospitals; hospital-level re-excision rates ranged from 5% to >50%. There was no statistically significant baseline difference in re-excision rates between SCW and nonparticipating hospitals (16.1% vs. 17.1%, P =0.47). Re-excision significantly decreased for SCW but not for nonparticipating hospitals (odds ratio=0.69, 95% confidence interval=0.52-0.91).ConclusionsBenchmarked performance reports and collaborative quality improvement can decrease post-BCS re-excisions, increase quality, and decrease costs. Our study demonstrates the effective use of administrative data as a platform for statewide quality collaboratives. Using existing data requires fewer resources and offers a new paradigm that promotes participation across practice settings.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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