Background: Data from BreastScreen Australia Screening and Assessment Services (SAS) for 2002-2010 were analysed to determine whether some SAS characteristics were more conducive that others to high screening performance, as indicated by high priority performance indicators and standards. Materials ...
Background: Data from BreastScreen Australia Screening and Assessment Services (SAS) for 2002-2010 were analysed to determine whether some SAS characteristics were more conducive that others to high screening performance, as indicated by high priority performance indicators and standards. Materials And Methods: Indicators investigated related to: numbers of benign open biopsies, screen-detected invasive cancers, and interval cancers, and wait times between screening and assessment. Multivariate Poisson regression was undertaken using as candidate predictors of performance, SAS size (screening volume), urban or rural location, year of screening, accreditation status, and percentages of clients from culturally and linguistically diverse backgrounds, rural and remote areas, and socio-economically disadvantaged areas. Results: Performance standards for benign biopsies and invasive cancer detection were uniformly met irrespective of SAS location and size. The interval cancer standard was also met, except in 2003 when the 95% confidence interval of the rate still incorporated the national standard. Performance indicators improved over time for: benign open biopsy for second or subsequent screening rounds; rates of invasive breast cancer detection for second or subsequent screening rounds; and rates of small cancer detection. No differences were found over time in interval cancer rates. Interval cancer rates did not differ between non-metropolitan and metropolitan SAS, although state-wide SAS had lower rates. The standard for wait time between screening and assessment (being assessed ${\leq}28$ days) was mostly unmet and this applied in particular to SAS with high percentages of culturally and linguistically diverse women in their screening populations. Conclusions: Gains in performance were observed, and all performance standards were met irrespective of SAS characteristics, except wait times to assessment. Additional descriptive data should be collected on SAS characteristics, and their associations with favourable screening performance, as these may be important when deciding on SAS design
Background: Data from BreastScreen Australia Screening and Assessment Services (SAS) for 2002-2010 were analysed to determine whether some SAS characteristics were more conducive that others to high screening performance, as indicated by high priority performance indicators and standards. Materials And Methods: Indicators investigated related to: numbers of benign open biopsies, screen-detected invasive cancers, and interval cancers, and wait times between screening and assessment. Multivariate Poisson regression was undertaken using as candidate predictors of performance, SAS size (screening volume), urban or rural location, year of screening, accreditation status, and percentages of clients from culturally and linguistically diverse backgrounds, rural and remote areas, and socio-economically disadvantaged areas. Results: Performance standards for benign biopsies and invasive cancer detection were uniformly met irrespective of SAS location and size. The interval cancer standard was also met, except in 2003 when the 95% confidence interval of the rate still incorporated the national standard. Performance indicators improved over time for: benign open biopsy for second or subsequent screening rounds; rates of invasive breast cancer detection for second or subsequent screening rounds; and rates of small cancer detection. No differences were found over time in interval cancer rates. Interval cancer rates did not differ between non-metropolitan and metropolitan SAS, although state-wide SAS had lower rates. The standard for wait time between screening and assessment (being assessed ${\leq}28$ days) was mostly unmet and this applied in particular to SAS with high percentages of culturally and linguistically diverse women in their screening populations. Conclusions: Gains in performance were observed, and all performance standards were met irrespective of SAS characteristics, except wait times to assessment. Additional descriptive data should be collected on SAS characteristics, and their associations with favourable screening performance, as these may be important when deciding on SAS design
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문제 정의
Australia’s national breast cancer screening program, BreastScreen Australia, was introduced by Commonwealth, state and territory governments in 1991 and directed primarily at 50-69 year old women using biennial mammography (BreastScreen Australia, 2009). The principal aim of the program is to reduce breast cancer mortality and morbidity.
The study demonstrates the value of using routine data reporting for assessing performance characteristics of BreastScreen Australia at a system level. It is recommended that more detailed descriptive characteristics of SAS be collected in the future to add value to these types of analyses.
제안 방법
A BreastScreen Australia Data Dictionary was employed by Services to promote operational consistency in data recording (National Quality Management Committee, 2004). Accreditation measures and performance indicators selected for this study comprised benign open biopsy rates, detection rates for invasive cancers (all sizes) and assessment. These were chosen to assess SAS performance interval cancer rates, and time between screening and assessment.
Results indicate that rates of detection of invasive cancers of all sizes and of small cancers specifically have increased over time, while the need for benign open biopsy has reduced, and interval cancer rates have stayed within acceptable limits. Further data are needed on Service characteristics to better identify those characteristics associated with better Service outcomes, in order to inform Service design planning.
Overall monitoring reports for the BreastScreen Australia program are provided annually by the Australian Institute of Health and Welfare (BreastScreen Australia, 2009; AIHW, 2010; 2012).The present study is complementary in that it focuses on screening performance by characteristics of individual SAS, using BreastScreen Australia accreditation standards and performance indicators.
The program aims to derive its performance indicators from the best evidence available, in order to achieve positive screening outcomes (BreastScreen Australia,2004; 2005;2009). SAS performance is monitored against performance indicators, and national accreditation standards, and levels of accreditation are awarded using a decision-making tool (BreastScreen Australia, 2004).
These were chosen to assess SAS performance interval cancer rates, and time between screening and assessment. These were chosen to assess SAS performance in achieving a cancer diagnosis without need for open biopsy, avoiding unnecessary open biopsies, achieving an acceptable cancer detection rate, and avoiding unnecessary anxiety in women from undue delays in obtaining assessment of screen-detected abnormalities.
대상 데이터
3 million women aged 50-69 years were screened through the program, comprising 55% of the Australian female population in that age range (AIHW, 2012). Currently the program is delivering screening services at over 600 locations, using fixed, relocatable and mobile units administered by 32 Screening and Assessment Services (SAS) (AIHW, 2012). SAS vary in their coverage, with some covering states and territories with comparatively small populations (i.
This paper was prepared on behalf of the BreastScreen Australia National Quality Management Committee (NQMC). Members of the Committee not listed as authors include Dr Tracey Bessell (Acting Chair), Ms Pam Brackman, Ms Roberta Higginson, Associate Professor Warwick Lee, Mr Warwick May, Ms Helen Porritt, Ms Michelle Tornabene, Ms Jan Tresham and Clinical Associate Professor Liz Wylie. Cancer Australia provided the Secretariat support to the NQMC, including undertaking the analysis for this paper.
성능/효과
In conclusions, all high priority standards were met nationally by the Breast Screen Australia Service categories used in this study, apart from the proportion meeting the standard for wait time from screening to assessment. The higher the percentage of culturally and linguistically diverse women among those being screened by the Service, the lower was the percentage of screened women meeting the national accreditation standard of 28 days or less between screening and assessment.
4) were uniformly met by year, SAS location and size (Table 1). Regression analysis confirmed that State-wide SAS had a higer hate of benign open biopsies than metropolitan SAS among women undergoing assessment following their first screen [rate ratio (95% confidence interval) for State- wide compared with metropolitan rates=1.39 (1.11-1.73)] (Table 2). By comparison, the rate for non-metropolitan services was similar to that for metropolitan SAS [rate ratio=0.
The higher the percentage of culturally and linguistically diverse women among those being screened by the Service, the lower was the percentage of screened women meeting the national accreditation standard of 28 days or less between screening and assessment. Results indicate that rates of detection of invasive cancers of all sizes and of small cancers specifically have increased over time, while the need for benign open biopsy has reduced, and interval cancer rates have stayed within acceptable limits. Further data are needed on Service characteristics to better identify those characteristics associated with better Service outcomes, in order to inform Service design planning.
후속연구
, 2010). Further research is underway in other Australian states to broaden the evidence base.
Interval cancer rates are an important marker of screening sensitivity. It is reassuring that performance standards were uniformly met by SAS category, but the lower rates of interval cancers for state-wide than metropolitan SAS were unexpected and further investigation into possible reasons is required, including the possible contribution of higher screen-reader volume and consequent expertise in state-wide SAS. Small SAS tended to have lower small-cancer detection rates, which may have been influenced by smaller screen-reader volume.
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