Quality Monitoring of Melanoma Care: Report on Outcomes of First 500 cases after implementation of Comprehensive quality monitoring program
Laurence E McCahill, *Barrett Kielhorn, *Mark Kosten, *Jensen Jantz
Metro Health University of Michigan Health, Wyoming, MI
Objective: To assess adherence to quality measures of melanoma clinical care following implementation of a comprehensive quality assessment program at a community skin cancer center. Design: Thirty quality metrics based on published, expert panel recommendations for melanoma quality were adopted. Cases were abstracted consecutively, quality monitoring done quarterly and public reporting annually. Setting: University-Affiliated Community Hospital Patients: Patients with melanoma treated from January 2013 to December 2019. Main Outcome Measures: Compliance with 18 surgical measures, 7 pathology measures and 5 multidisciplinary measures. Results: There were 546 patients treated for melanoma, mean age of 63.0 years (range 18-96), 57.7% were men. 492 (90.1%) were initial diagnosis and 54 (9.9%) were evaluated for recurrent disease. Tumor location for initial diagnoses was Head & Neck in 102(20.7%), trunk 209(42.5%) and extremity 174(35.4%) and unknown primary 7 (1.4%). 440 underwent initial surgical resection. For surgical quality measures, we demonstrated clinical stage documentation in 440(100%); appropriate surgical margins selected in 439(99.8%), and pathologic clear margins in 97.8%. SLN biopsy was discussed in all 276 (100%) clinical stage Ib/II patients, and a SLN was identified in 277/287 (96.5%) of patients undergoing SLN biopsy, with a mean of 1.95 nodes identified. Among patients undergoing lymphadenectomy, 31/34 (91.2%) met recommended node counts. 0/363 patients with early stage disease underwent CT imaging, and 133/135 (98.5%) of advanced stage patients had adjuvant therapy discussed. Pathology measures of reporting were met in >95% of case, and a surveillance plan identified in 99.6% Conclusion: We have developed a unique quality monitoring process assessing 30 measure of melanoma care delivery. We believe this continuous assessment and annual public reporting has been instrumental towards high compliance with guideline-based care.
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