National accreditation improves compliance with quality measures
Steven D Wexner MD PhD(Hon)
Surgeon, Educator, Researcher, Author, Innovator, and Communications Leader; Past Vice Chair, Board of Regents at American College of Surgeons; Chair National Accreditation Program for Rectal Cancer
The national accreditation program for breast centers (NAPBC) was established in 2008 by the American College of Surgeons (ACS) through the Commission on Cancer (CoC). This program was designed to be a quality improvement initiative. One of the NAPBC measures includes the requirement for postoperative radiation (PR) for patients with ≥ four positive lymph nodes. Under the direction of the medical director of the cancer programs for the ACS including the executive director of the CoC, Dr. David Winchester, a study was undertaken to evaluate the impact of accreditation on compliance with this quality metric. Berger et al published their findings in the Journal of the American College of Surgeons. Specifically, data from 477 NAPBC accredited centers and 958 CoC accredited centers who were not also accredited within the NAPBC program underwent mastectomy between 2006 to 2013. Thirty-four thousand seven hundred fifty-two patients from these institutions had ≥ four positive lymph nodes of whom only 21,638 patients (62.3%) received PR. The authors found that compliance with this metric was significantly higher in the NAPBC centers than in the CoC centers at 66% versus 59.2% (p < 0.001). They found that compliance increased in the year prior to accreditation and continued to increase in post accreditation years. The authors clearly demonstrated that NAPBC accreditation correlated with improved compliance the PR. This study is of importance to surgeons who perform rectal cancer surgery given the significant work done by the OSTRiCh consortium terminated in the creation of the ACS CoC National Accreditation Program for Rectal Cancer (NAPRC) under the direction of the ACS and the CoC. (Abbas et al; Monson et al; Berho et al; Probst et al; Rickles et al; Wexner et al; Lee et al; Brady et al) I applaud the authors for this excellent study which lends further support for the critical concept of accreditation of cancer centers for treatment of specific types of cancer.
