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Improvement of best practice in early breast cancer: actionable surgeon and hospital factors

  • Epidemiology
  • Published:
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Abstract

To identify actionable elements for improving best practice, this study examined the relative effects of patient, surgeon and hospital factors on surgical treatment variation of 2,929 early breast cancer patients, diagnosed from January 1998 to January 2002 in the region of the Comprehensive Cancer Centre North-Netherlands. Multilevel logistic regression was used to analyze the hierarchically structured data. Apart from the patient level, 43.3% of the treatment variation was due to the hospital and 56.7% to the surgeon, after adjustment for patient characteristics. Although hospital factors like volume, teaching status, and management and policy contributed to this variation, multidisciplinary care seemed the most important actionable hospital factor. Although the surgeon was shown to be an important starting point for quality improvement, actionable elements seemed difficult to identify as factors like surgeon experience and volume were not conclusive and significant variance on this level remained (σ2 = 0.149, SE 0.053). We conclude that multidisciplinary care can improve best practice and that further research into actionable surgeon factors is needed.

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Authors and Affiliations

  1. Faculty of Management and Organization, University of Groningen, P.O. Box 800, 9700, AV, Groningen, The Netherlands

    Marjan Gort & Manda Broekhuis

  2. Comprehensive Cancer Centre North-Netherlands (CCCN), P.O. Box 330, 9700, AH, Groningen, The Netherlands

    Marjan Gort & Renée Otter

  3. Department of Social Medicine, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands

    Niek S. Klazinga

Authors
  1. Marjan Gort
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  2. Manda Broekhuis
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  3. Renée Otter
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  4. Niek S. Klazinga
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Correspondence to Marjan Gort.

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Gort, M., Broekhuis, M., Otter, R. et al. Improvement of best practice in early breast cancer: actionable surgeon and hospital factors. Breast Cancer Res Treat 102, 219–226 (2007). https://doi.org/10.1007/s10549-006-9327-4

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  • DOI: https://doi.org/10.1007/s10549-006-9327-4

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