OBJECTIVES: Identifying replicable mechanisms that can govern the expenditure and appropriateness of Healthcare System is important to guarantee the sustainability. A pilot study was performed in ASL CN2 to evaluate performance in breast cancer diagnosis and treatment, using the methodology E.Pic.A. proposed by Massa et al.(1).

METHODS: A board of professionals identified 7Key Performance Indicators (KPIs) on the basis of the current guidelines from the Italian Association Oncology. Data were gathered from real-word sources. Stage of breast cancer was defined through the tumor, node, metastasis [TNM] staging of the pathology report obtained at surgery.

RESULTS: A cohort of 95 patients underwent surgery of breast cancer at ASL CN2 in 2015 was included in this study. Respectively, 4% (KPI1) and 44% (KPI2) of patients with tumor stage I and II performed one diagnostic examinations within 2 months before and after surgery; In KPI3 none of the patients received subsequent axillary dissection and/or breast reconstruction within 3 months after mastectomy; In KPI4 20% of patients received surgical re-intervention with a mean time of 79 days; In KPI5 58% of patients received adjuvant chemotherapy within 60 days after surgery; In KPI6 57% of patients performed radiotherapy within 90 days after surgery (who did not receive adjuvant chemotherapy) and 69% within 180 days after surgery (who received adjuvant chemotherapy); In KPI7 74% of the patients with tumor stage I and II performed one diagnostic examinations within 365 months after surgery.

CONCLUSIONS: This study sustains the replicability of E.Pic.A. in different realities, the use of the KPIs to measure the performance is a way to guarantee a homogenous level of care regardless where the treatment is performed. Potentially, the improvement of these KPIs could lead to cost savings coming from inefficiencies that could be relocated to higher-value interventions for patients.

References: