Aiello Bowles et al. BMC Cancer 2012, 12:136 http://www.biomedcentral.com/1471-2407/12/136 databases with which to evaluate quality of breast cancer care, only one (the NQMBC program) appears to collect the level of detail needed to evaluate quality of surgical care. These databases also rely solely on self-reported information from providers who opt-in to each system, and may be more likely to involve high volume breast surgeons. These providers may not be representative of the national population of surgeons because many sur- geons performing breast surgery in the United States are neither high volume breast surgeons nor work within a certified breast center [8]. Our study collected data on every surgeon who performs breast procedures at one of four geographically disparate institutions, with variable volume in breast surgery. Standardizing clinical data col- lection and reporting efforts across programs and data- bases (including ours), with institutional participation rather than voluntary, and publicly reporting results will likely be necessary to develop timely benchmarks for surgical quality. Additional programming work, such as Natural Language Processing, may help improve data collection timeliness and efficiency by automatically interpreting text from electronic medical records, thus reducing the need for manual abstraction. Creating stan- dard templates in electronic medical records for pathol- ogy and surgery reports may be another method that can improve both quality and consistency of data col- lected and reported. We hope the work from BRCASO provides a stepping stone for research on and develop- ment of standard surgical quality measures that can be generalized to and implemented by other providers and institutions. Additional material Additional file 1: BRCASO chart abstraction manual. Detailed chart abstraction methods and protocol used in the BRCASO study. Acknowledgements This study was funded by the National Cancer Institute, American Recovery and Reinvestment Act, grants Improving Breast Cancer Surgery Effectiveness Through Establishment of an Electronic Cancer Surgery Database (1RC1 CA 145402, PI: L. McCahill) and Cancer Research Network Across Health Care Systems U19 CA 79689 (PI: E. Wagner) Author details 1Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. 2Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave, Suite 300, Denver, CO 80237, USA. 3Van Andel Research Institute, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA. 4Lacks Cancer Center, Saint Mary’s Health Care, 250 Cherry St, Grand Rapids, MI 49503, USA. 5Marshfield Clinic Research Foundation, Marshfield Clinic, 1000 North Oak Ave, Weston, WI 54449, USA. 6Fletcher Allen Health Care, Colchester Avenue, Burlington, VT 05401, USA. 7College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USA. Page 7 of 7 Authors’ contributions EJAB, HSF, RS, AO, TAJ, and LEM conceived of the study, and participated in its design and coordination and helped to draft the manuscript. TB and AS developed the electronic database for data collection, prefilled all electronic administrative data, and helped draft the manuscript. KaB, KiB, JE, GG, and JSJ developed study materials, including the chart abstraction manual, trained and provided support to abstractors, and helped draft the manuscript. All authors have read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 3 August 2011 Accepted: 3 April 2012 Published: 3 April 2012 References 1. IOM: Crossing the quality chasm: a new health system for the 21st century Washington: National Academy Press; 2001. 2. Wasif N, Cormier JN, Ko CY, McCahill LE, Edge SB, Wong SL, Anthony T, Kollmorgen D, Marcus SG, Bleznak A, et al: Quality measurement in cancer care delivery. Ann Surg Oncol 2011, 18(3):611-618. 3. Aiello Bowles EJ, Tuzzio L, Wiese CJ, Kirlin B, Greene SM, Clauser SB, Wagner EH: Understanding high-quality cancer care: a summary of expert perspectives. Cancer 2008, 112(4):934-942. 4. McCahill LE, Privette A, James T, Sheehey-Jones J, Ratliff J, Majercik D, Krag DN, Stanley M, Harlow S: Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons. Arch Surg 2009, 144(5):455-462, discussion 462-453. 5. Wagner EH, Greene SM, Hart G, Field TS, Fletcher S, Geiger AM, Herrinton LJ, Hornbrook MC, Johnson CC, Mouchawar J, et al: Building a research consortium of large health systems: the cancer research network. J Natl Cancer Inst Monogr 2005, 35:3-11. 6. Neuss MN, Desch CE, McNiff KK, Eisenberg PD, Gesme DH, Jacobson JO, Jahanzeb M, Padberg JJ, Rainey JM, Guo JJ, et al: A process for measuring the quality of cancer care: the quality oncology practice initiative. J Clin Oncol 2005, 23(25):6233-6239. 7. American College of Surgeons Commission on Cancer. [http://www.facs. org/cancer/index.html]. 8. Clifford EJ, De Vol EB, Pockaj BA, Wilke LG, Boughey JC: Early results from a novel quality outcomes program: the American Society Of Breast Surgeons’ Mastery of Breast Surgery. Ann Surg Oncol 2010, 17(Suppl 3):233-241. 9. National Accreditation Program for Breast Centers. [http:// accreditedbreastcenters.org/]. 10. Kaufman CS, Shockney L, Rabinowitz B, Coleman C, Beard C, Landercasper J, Askew JB Jr, Wiggins D, Quality Initiative C: National Quality Measures for Breast Centers (NQMBC): a robust quality tool: breast center quality measures. Ann Surg Oncol 2010, 17(2):377-385. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2407/12/136/prepub doi:10.1186/1471-2407-12-136 Cite this article as: Aiello Bowles et al.: Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO) research database. BMC Cancer 2012 12:136.