Key performance indicators for monitoring the integrated care pathway in breast cancer: the E.Pic.A. project
Keywords:Appropriateness, Breast cancer, Italian National Health System, Key performance indicators, Sustainability
Background: Due to its high incidence, evaluating performance of care delivered to breast cancer patients is a crucial issue. The multidisciplinary panel E.Pic.A. (Economic Appropriateness of an Integrated Care Pathway) defined a set of key performance indicators (KPIs) to evaluate economic waste in breast cancer healthcare interventions.
Methods: The E.Pic.A. panel identified the principal KPIs that are crucial within the breast cancer care pathway to evaluate the performance of care. KPIs were defined taking into account their reliability, validity, usability and feasibility of measurement through the linkage between multiple routine healthcare data sources.
Results: Seven KPIs were identified: three on instrumental diagnostics, two on surgery and two on treatment. The three KPIs regarding instrumental diagnostics are aimed at assessing the inappropriateness of diagnostic tests performed before and after the index surgery. The two KPIs regarding surgery measure the inappropriateness of possible repeated interventions considering the time elapsed from the index surgery. The two KPIs regarding oncologic therapy measure the inappropriateness about the administration time of adjuvant therapy and radiotherapy considering the time elapsed from the index surgery.
Conclusion: E.Pic.A methodology could help to evaluate economic waste in healthcare interventions with the objective of redirecting resources to interventions with greater value. (HTA & Market Access)
Bloomberg. Where do you get the most for your health care dollar? 2014. https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html. Accesso Maggio 2018.
Osservatorio Nazionale sull’impiego dei Medicinali. L’uso dei farmaci in Italia. Rapporto Nazionale 2015. Roma: Agenzia Italiana del Farmaco 2016. [Article in Italian].
Il monitoraggio della spesa sanitaria. http://www.rgs.mef.gov.it/_Documenti/VERSIONE-I/Attivit--i/Spesa-soci/Attivit-monitoraggio-RGS/2017/IMDSS-RS2017.pdf. [Article in Italian].
Legge di Bilancio 2018-2020. http://www.gazzettaufficiale.it/eli/id/2017/12/29/17G00222/sg. [Article in Italian].
Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012 Apr 11;307(14):1513-1516. doi: 10.1001/jama.2012.362. [Epub 2012 Mar 14].
Gray M, Jani A. Promoting triple value healthcare in countries with universal healthcare. Healthc Pap. 2016;15(3):42-48.
I numeri del cancro in Italia 2017. Gruppo di lavoro AIOM – AIRTUM – Fondazione AIOM. http://www.registri-tumori.it/PDF/AIOM2017/2017_numeri_del_cancro.pdf [Article in Italian].
Deandrea S, Lerda D, López Alcalde J, Neamtiu L, Saz-Parkinson Z, Ulutürk A. Review and analysis of external quality assessment of breast cancer services in Europe. Luxembourg: Publications Office of the European Union 2015; 108 pp. http://publications.jrc.ec.europa.eu/repository/bitstream/JRC96105/lfna27413enn.pdf.
Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010 Sep;46(13):2344-2356. doi: 10.1016/j.ejca.2010.06.119. [Epub 2010 Jul 31].
van Dam PA, Tomatis M, Marotti L, et al. The effect of EUSOMA certification on quality of breast cancer care. Eur J Surg Oncol. 2015 Oct;41(10):1423-1429.
Parmenter D. Key performance indicators: developing, implementing, and using winning KPIs. Hoboken, NJ: Wiley 2015. ProQuest Ebook Central. https://0-ebookcentral-proquest-com.opac.unicatt.it/lib/unicatt-ebooks/detail.action?docID=1895928.
Associazione Italiana di Oncologia Medica (AIOM). Linee guida: neoplasie della mammella. 2016 Edition. Updated to October 19, 2016. https://www.aiom.it/linee-guida-aiom-2018-neoplasie-della-mammella-11/. [Article in Italian].
US National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: breast cancer (version 2.2016). 2016. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Ultimo Accesso Maggio 2018.
Programma Nazionale Esiti (PNE). http://www.agenas.it/images/agenas/pne/SINTESI_PNE_2017_19_DICEMBRE.pdf [Article in Italian].
Linee Guida AIOM. Neoplasie della mammella [Breast neoplasms]. Edizione 2017. Aggiornamento Novembre 16, 2017. [Article in Italian].
Biganzoli L, Marotti L, Hart CD, et al. Quality indicators in breast cancer care: An update from the EUSOMA working group. Eur J Cancer 2017 Nov;86:59-81.
Massa I, Balzi W, Burattini C, et al. The challenge of sustainability in healthcare systems: frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study). The Breast. 2017;34:103e107.
How to Cite
Copyright (c) 2019 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to AboutOpen agree to publish their articles under the Creative Commons NonCommercial 4.0 International License (CC BY-NC 4.0), which allows third parties to copy and redistribute the material providing appropriate credit and a link to the license but does not allow to use the material for commercial purposes and to use the material if it has been remixed, transformed or built upon.