***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND We have little systematic information about the extent to which st and ard processes involved in health care -- a key element of quality --are delivered in the United States . METHODS We telephoned a r and om sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences . We also received written consent to copy their  medical records  for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care . We then constructed aggregate scores . RESULTS Participants received 54.9 percent ( 95 percent confidence interval , 54.3 to 55.5 ) of recommended care . We found little difference among the proportion of recommended preventive care provided ( 54.9 percent ) , the proportion of recommended acute care provided ( 53.5 percent ) , and the proportion of recommended care provided for chronic conditions ( 56.1 percent ) . Among different medical functions , adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care . Quality varied substantially according to the particular medical condition , ranging from 78.7 percent of recommended care ( 95 percent confidence interval , 73.3 to 84.2 ) for senile cataract to 10.5 percent of recommended care ( 95 percent confidence interval , 6.8 to 14.6 ) for alcohol dependence . CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public . Strategies to reduce these deficits in care are warranted CONTEXT Between 1993 and 1994 , the 80 physicians in the French comprehensive cancer center , Léon Bérard , developed and implemented a Clinical Practice Guidelines ( CPGs ) project based on an analysis of the literature and a consensus of intrainstitutional experts . OBJECTIVE The aims of this project are to assist community-based oncologists in their decision making and to minimize inappropriate variation in practice s. A study was design ed to assess the impact of  CPGs  on management of breast and colon cancer . DESIGN A " before-after " study , using institutional computerized records of patients with breast or colon cancer . SETTING Records for 100 women with localized breast cancer were r and omly selected from those available in 1993 and 1995 , and those for all patients newly referred with colon cancer in 1993 and 1995 ( 77 and 81 patients , respectively ) . Medical decisions on these records were analyzed to assess their compliance with the CPGs .  ( A systematic search of the literature was performed to determine the scientific evidence for noncompliant decisions . ) RESULTS Of 375 available medical decisions , 350 were assessable . The compliance rate with CPGs for breast cancer was significantly higher in 1995 compared with 1993 , 54 % ( 54/99 ; 95 % confidence interval [ CI ] , 44%-64 % ) vs 19 % ( 18/95 ; 95 % CI , 11%-27 % ) ( P<.001 ) . The compliance rate for colon cancer was also significantly higher in 1995 than in 1993 , 70 % ( 62/88 ; 95 % CI , 60%-80 % ) vs 50 % ( 34/ 68 ; 95 % CI , 38%-62 % ) ( P=.009 ) . In 1993 , 42 % ( 40/95 ; 95 % CI , 32%-52 % ) of medical decisions for breast cancer and in 1995 , 68 % ( 67/99 ; 95 % CI , 59%-77 % ) conformed with the CPGs or were judged to be based on " scientific evidence . " In 1993 , 71 % ( 48/68 ; 95 % CI , 60%-81 % ) of medical decisions for colon cancer , and in 1995 81 % ( 71/88 ; 95 % CI , 73%-89 % ) conformed with the CPGs or were judged to be based on scientific evidence . CONCLUSIONS Compliance rates were significantly higher in 1995 for both cancers . The development and implementation of CPGs for cancer management seem to result in significant changes in medical practice , although a causal relationship between changes and CPGs is not demonstrated in this study PURPOSE To investigate the effects of the Interactive Breast Cancer CDROM as a decision aid for breast cancer patients with a choice between breast conserving therapy ( BCT ) and mastectomy ( MT ) .  PATIENTS AND METHODS Consecutive patients with stage I and II breast cancer were enrolled . A quasi-experimental , longitudinal , and pretest/posttest design was used . Follow-up was scheduled 3 and 9 months after discharge from the hospital . Control patients ( n = 88 ) received st and ard care ( oral information and brochures ) . The CDROM was provided to patients in the experimental condition ( n = 92 ) as a supplement to st and ard procedures . Outcome variables were treatment decision , satisfaction , and quality of life ( QoL ) . RESULTS No effect on treatment decision was found . CDROM patients expressed more general satisfaction with information at 3 and 9 months ( 95 % confidence interval for the difference ( d ) between the means ( d : 4.1 to 12.5 and 5.7 to 14.2 respectively ) . CDROM patients were also more satisfied with their treatment decision at 3 and at 9 months ( d : 0.1 to 0.4 ; 0.2 to 0.5 ) . Moreover , at 9 months , CDROM patients were more satisfied with breast cancer-specific information ( d : 0.9 to 16.5 ) , the decision-making process ( d : 0.1 to 0.4 ) , and communication ( d : 0.2 to 11.0 ) . At 3 and 9 months , a positive effect was found on general health ( d : 0.2 to 14.5 and 0.3 to 15.0 ) . Moreover , at 9 months , CDROM patients reported better physical functioning ( d : 5.1 to 19.8 ) , less pain ( d : -17.9 to -4.5 ) , and fewer arm symptoms ( d : -14.1 to -0.5 ) . CONCLUSION The Interactive Breast Cancer CDROM improved decision making in patients with early-stage breast cancer with a choice between BCT and MT , as evaluated in terms of patients ' satisfaction and BACKGROUND AND PURPOSE The International Breast Cancer Study Group ( IBCSG ) has developed and approach for assessing the impact of adjuvant therapy on quality of life ( QL ) within the framework of international , multilingual clinical trials . The major steps are summarized . Conceptual , method ological and practical issues are discussed with reference to results of two trials closed to accrual ( IBCSG VI , VII ) and one subsequent ongoing trial ( IBCSG IX ) . PATIENTS AND METHODS QL was assessed in pre- and post-menopausal patients with operable breast cancer . Various  single-item linear analogue self- assessment ( LASA ) scales  were used as indicators of components of QL , including global indicators of well-being , functioning and health perception , and specific indicators of symptoms of disease and treatment . In trials VI and VII , QL was assessed at baseline , during adjuvant treatment and follow-up , and at recurrence . Based on this experience , the QL form was revised for subsequent trials and further investigated in a sub sample of patients r and omized into trial IX . RESULTS In trials VI and VII , the QL indicators were responsive to the impact of biomedical factors at baseline , various adjuvant treatments , changes over the first 18 months , and recurrence . In trial IX , the revised QL form was well accepted by patients and staff . Completing this form did not exceed five minutes . QL differences between on and off cytotoxic treatment strengthen the cl aim that these measures are responsive . Correlations and logistic regression analyses show the expected relationship among the various global and specific indicators . CONCLUSION Results from two trials closed to accrual and an ongoing trial confirm the feasibility , validity and clinical relevance of the IBCSG approach for study ing the impact of adjuvant breast cancer therapy on QL in international clinical trials 
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This observation highlights a gap between ideal and actual care — that is , between what evidence has identified as recommended care and what Americans actually receive .
Quality measures can highlight health care quality through the identification of gaps in care .
Quality measures can address the question of how many women qualifying to receive a st and ard of breast cancer care by virtue of their clinical situation actually receive that care in timely fashion .
Seen from a slightly different perspective , the question could be , How many health care professionals , when attending to women qualifying to receive a st and ard of breast cancer care by virtue of their clinical situation , actually deliver that care in timely fashion ?
Ideally , quality indicators , and thus quality measures , are supported by scientific medical evidence ( i.e. , “ evidence based ” ) , indicating that the care ( e.g. , radiotherapy after breast-conserving surgery ) is linked to improved patient outcomes .