Annelotte van Bommel

19 The NABON Breast Cancer Audit INTRODUCTION Quality of health care has become subject of public debate. Until recently, quality of breast cancer care was merely enhanced by national organizations such as the National Breast Cancer Organization Netherlands (NABON) that defined and distributed guidelines that contained multidisciplinary criteria for providing good quality breast cancer care as well as actual treatment guidelines. 1 Today’s society demands transparency, resulting in a call for the evaluation of quality of care as provided by the individual institutions. In the Netherlands, the Dutch Health Care Inspectorate started querying surgical departments a decade ago for a number of quality aspects and national media began to report on the observed variation of hospital-specific indicator results. In 2008, the Dutch Health Care Inspectorate observed a high rate of tumor- positive margins after breast conserving surgery in a number of hospitals in the Netherlands 2 , urging the need for a national audit for the monitoring of the quality of breast cancer care in individual hospitals. Concurrently, clinicians of various disciplines were seeking benchmarked performance information to monitor the quality of their delivered breast cancer care which could catalyze quality improvements in the care delivered to their patients. 3 The aims of the present study were to describe the development of the NABON Breast Cancer Audit (NBCA) and report on the results of the first 4 years of nationwide clinical auditing of multidisciplinary breast cancer care in the Netherlands. METHODS The creation of the NABON Breast Cancer Audit (NBCA) Close cooperation of the NABON, the Comprehensive Cancer Organization the Netherlands (IKNL) and the Dutch Institute for Clinical Auditing (DICA) led to the institution of the NBCA in 2011. 4 NABON is a Dutch breast cancer working group that aims to improve breast cancer care in the Netherlands by developing 2