MQSA guidelines need improvement

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 - Breast screening

The Mammography Quality Standards Act (MQSA) guidelines for tracking outcomes and measuring quality indicators need to be strengthened for better assessment of quality of care, according to a study published online Nov. 21 in the American Journal of Roentgenology.

Created in 1992, MQSA was intended to improve the quality of breast cancer screening with mammography nationwide. Though its guidelines are meant to ensure the reliability, clarity, and accuracy of mammogram interpretations, they don’t require rigorous patient tracking.

“It is unclear the extent to which institutions are tracking or attempting to track additional data beyond those necessary to meet minimum MQSA requirements and whether the data are of sufficient quality to make statements about screening mammography quality,” wrote the study’s lead author, Garth H. Rauscher, PhD, of the University of Illinois at Chicago, and colleagues. “Little research has been done to examine how institutions go about tracking patients whose mammography results are abnormal, especially institutions performing screening mammography but not generally performing biopsies, and the level of success in obtaining follow-up information from other institutions.”

Thus, Rauscher and colleagues created a quality improvement project using data collected from screening mammography facilities to determine if they were able to calculate certain quality metrics and to show that they could meet certain benchmarks pertaining to quality of the mammography process.

Data provided from the participating facilities were from 2009 and corresponding diagnostic follow-up. Information included patients lost to follow-up, timing of diagnostic imaging and biopsy, cancer detection rates, and the proportion of cancer cases detected as minimal and early-stage tumors. Of the 52 institutions, the percentage of institutions that met each benchmark ranged from 27 to 83 percent. Facilities with the American College of Surgeons or the National Consortium of Breast Centers were more likely to meet benchmarks associated with cancer detection and early detection. Disproportionate share facilities, on the other hand, were less likely to meet benchmarks pertaining to care timeliness.

“To differentiate issues of tracking from issues of quality of care, it is crucial that complete tracking be performed so that results can be interpreted solely in terms of quality of care,” suggested the authors. “This will only happen in a general sense if MQSA is reauthorized and the guidelines for tracking outcomes and measuring quality indicators are strengthened to better reflect actual quality of care as suggested in 2005 by the National Cancer Program Board.”