Annelotte van Bommel

32 Figure 3. Boxplot of variation between hospitals in the percentage of patients with either invasive breast cancer or ductal carcinoma in situ (DCIS) discussed in a post-operative multidisciplinary team meeting, and digital report available (2011–2014) with median hospital performance and interquartile ranges. 2014 contains 9 months; from January 2014 to October 2014. DISCUSSION This paper describes the implementation of a system monitoring the quality of breast cancer care in the Netherlands via a nationwide multidisciplinary audit. All 92 hospitals currently delivering breast cancer care in the Netherlands participate in the NBCA and the results of the first 4 years of auditing show an overall high quality of care, areas where clear improvement has been achieved as well as unexplained variation. The collection of data in all hospitals in the Netherlands resulted in 56,927 patients for whomdetailed information regarding their work-up and treatment was available for analysis. Several initiatives have shown that improvement of quality of care can be established by measuring quality indicators over time 7–12 ; however, to the best of our knowledge we are the first to report on a nationwide breast cancer audit with full participation of all hospitals. The use of quality indicators embedded in a Mean hospital performance of patients discussed in a postoperative multidisciplinary teammeeting Year of surgery 2011 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2012 2013 2014