We thank Bell et al1 for their article in the November issue of Canadian Family Physician. This informative article captures key considerations for developing quality indicators or performance measures for primary care to support quality improvement initiatives.
The authors reference the mammogram screening indicator definition featured in the “MyPractice: Primary Care report technical appendix”2 by Health Quality Ontario (now part of Ontario Health):
The Health Quality Ontario “MyPractice: Primary Care report technical appendix,” version 4, provides an example of a performance measure for screening with mammography. This was defined as the “percentage of screen eligible female patients aged 52 to 69 years who had a mammogram within the past two years.” However, for most screening maneuvers there is a narrow trade-off between the potential for benefit and the potential for harm.1
Ontario Health, the government agency responsible for ensuring Ontarians receive high-quality health care services where and when they need them, agrees that benefits of mammograms for breast cancer screening in this age group might not always outweigh potential harms. Moreover, we fully acknowledge the critical roles that patient values, preferences, and choice play in clinical care. Ontario Health uses administrative databases to generate the MyPractice: Primary Care reports to minimize the burden of new data collection, understanding these databases do not capture patient choice, preferences, or values.
To balance this limitation and reflect the importance of shared decision making for breast cancer screening,3 the MyPractice: Primary Care report explicitly states the importance of discussing care options with patients:
We recognize that the current recommendation is to have an active discussion with women about the benefits and limitations of breast screening. Some women who are eligible to be screened choose not to. Thus, the data need to be interpreted in that context.4
Our MyPractice: Primary Care physician sample report can be found at https://hqontario.ca/quality-improvement/practice-reports/primary-care; page 13 specifically discusses breast cancer screening.
Footnotes
Competing interests
None declared
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