Impact of Quality Improvement Interventions on Biopsy-to-Treatment Time in Breast Cancer: Results from the PROMPT Quality Collaborative of the National Accreditation Program for Breast Centers

Abstract

Background: To address the interval between biopsy and first treatment, the National Accreditation Program for Breast Centers (NAPBC) launched Patient-Reported Observations for Medical Procedure Timeliness (PROMPT), a quality collaborative.

Methods: Participating PROMPT sites submitted data on the number of days from biopsy to first treatment (either surgery or neoadjuvant treatment (NAC)) before and after individual site-specific quality improvement (QI) projects using the American College of Surgeons Quality Framework. The study examined interventions of sites that reported successful projects and barriers for both successful and unsuccessful sites.

Results: Of 104 PROMPT sites, 62 (59.6 %) examined the time from biopsy to surgery, and 42 (40.4 %) analyzed the time from biopsy to NAC. Overall, 56 (53.8 %) sites decreased their interval from biopsy to treatment, from 50.3 to 38.8 days for biopsy to surgery and from 40.7 to 30.9 days for biopsy to NAC. No facility factors were associated with successfully decreasing this interval. The most common intervention for both intervals was enabling navigators to schedule appointments for surgeons and medical oncologists. Of 22 interventions for the interval from biopsy to surgery, the most common included hiring a breast surgeon and increasing operating room (OR) block time for surgeons. Of 17 interventions for the interval from biopsy to NAC, the most common were streamlining port-a-cath placements, ordering staging studies before seeing medical oncology, and offering concurrent medical oncology and surgery appointments.

Conclusions: Just more than half of the PROMPT sites improved their interval. Interventions to improve timely care include hiring staff and improving scheduling.

Keywords: Biopsy to treatment; Breast cancer; Neoadjuvant therapy; PROMPT collaborative; Patient navigation; Quality improvement; Surgical timeliness; Treatment delay.