Quality improvement in melanoma care: Multidisciplinary quality program development and comparison of care before and after implementation.

INTRODUCTION: Adherence to guideline-based care for melanoma remains suboptimal. This study describes the development of a quality monitoring program and compares the quality of care before and after its implementation.

METHODS: Thirty quality metrics were adopted. An abstraction tool, manual and electronic database were developed. Metrics were analyzed from 1/1/2008-8/31/2013 (Group A) and compared to melanoma care from 9/1/2013-12/31/2017 (Group B).

RESULTS: A total of 311 patients were treated from 2008 to 2017. Demographic data were similar between the groups. 21.7% of patients in Group A had clinical stage (TNM) documented before surgery compared to 100% in Group B. 86.9% of patients in Group A had surgical margins documented in the operative report compared to 100% of Group B. Appropriate surgical margins were obtained in 85.7% of Group A compared to 99.5% in Group B. Pathology reporting of margin status, satellitosis, regression and mitotic rates improved from ∼60% Group A to >92% in Group B. Multidisciplinary process and structural metrics were unchanged.

CONCLUSIONS: A comprehensive melanoma quality program has produced significantly improved guideline-based multidisciplinary care.