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Perrey HM, Taylor E, Cropp BF, Bumpus MJ, Lessard S, Pretorius JA, Angus JH, Duperreault MF, Snow A, Wang D, Curtis M, Couture LA, Adolphson DR, Smith K, Moody JH, Bianchi MJ, Parker MG, Sanyal A, Remick SC. Seeking American Society of Clinical Oncology-Quality Oncology Practice Initiative (ASCO-QOPI) certification in a northern New England rural health system and cancer care network. Learn Health Syst 2024; 8:e10415. [PMID: 39036533 PMCID: PMC11257055 DOI: 10.1002/lrh2.10415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 07/23/2024] Open
Abstract
In 2006 following several years of preliminary study, the American Society of Clinical Oncology (ASCO) launched the Quality Oncology Practice Initiative (QOPI). This cancer-focused quality initiative evolved considerably over the next decade-and-a-half and is expanding globally. QOPI is undoubtedly the leading standard-bearer for quality cancer care and contemporary medical oncology practice. The program garners attention and respect among federal programs, private insurers, and medical oncology practices across the nation. The MaineHealth Cancer Care Network (MHCCN) has undergone expansive growth since 2017. The network provides cancer care to more than 70% of the cases in Maine in a largely rural health system in Northern New England. In fall 2020, the MHCCN QOPI project leadership, following collaborative discussions with the ASCO-QOPI team, elected to proceed with a health system-cancer network-wide QOPI certification. Key themes emerged over the course of our two-year journey including: (1) Developing a highly interprofessional team committed to the project; (2) Capitalizing on a single electronic medical record for data transmission to CancerLinQ; (3) Prior experience, especially policy development, in other cancer-focused accreditation programs across the network; and (4) Building consensus through quarterly stakeholder meetings and awarding Continuing Medical Education (CME) and American Board of Medical Specialists (ABMS) Maintenance of Certification (MOC) credits to oncologists. All participants demonstrated a genuine spirit to work together to achieve certification. We report our successful journey seeking ASCO-QOPI certification across our network, which to our knowledge is the first-of-its-kind endeavor.
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Affiliation(s)
- Hilary M. Perrey
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Evelyn Taylor
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Brett F. Cropp
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meaghan J. Bumpus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Shannon Lessard
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jeanette A. Pretorius
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Jonathan H. Angus
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Megan F. Duperreault
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Amanda Snow
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Dorothy Wang
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Meredith Curtis
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Lauren A. Couture
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - David R. Adolphson
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Kimberly Smith
- Harold Alfond Center for Cancer Care at Maine General Medical CenterAugustaMaineUSA
| | - Joy H. Moody
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Michael J. Bianchi
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
| | - Amit Sanyal
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
| | - Scot C. Remick
- Departments of Information Technology, Medical Education, Medicine, Nursing and Pharmacy, MaineHealth Performance Improvement TeamMaineHealth, MaineHealth Cancer Care Network, and Maine Medical CenterPortlandMaineUSA
- Department of MedicineTufts University School of MedicineBostonMassachusettsUSA
- ASCO MembersAlexandriaVirginiaUSA
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Alonso-Jáudenes Curbera G, Gómez-Randulfe Rodríguez MI, Alonso de Castro B, Silva Díaz S, Parajó Vázquez I, Gratal P, López López R, García Campelo R. Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain. BMJ Open Qual 2024; 13:e002732. [PMID: 38901878 PMCID: PMC11191778 DOI: 10.1136/bmjoq-2023-002732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Evaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology's (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is an international initiative that evaluates quality of care in outpatient oncology practices. METHODS We retrospectively reviewed free-text electronic medical records from patients with breast cancer (BR), colorectal cancer (CRC) or non-small cell lung cancer (NSCLC). In a baseline measurement, high scores were obtained for the nine disease-specific measures of QCP Track (2021 version had 26 measures); thus, they were not further analysed. We evaluated two sets of measures: the remaining 17 QCP Track measures, as well as these plus other 17 measures selected by us (combined measures). Review of data from 58 patients (26 BR; 18 CRC; 14 NSCLC) seen in June 2021 revealed low overall quality scores (OQS)-below ASCO's 75% threshold-for QCP Track measures (46%) and combined measures (58%). We developed a plan to improve OQS and monitored the impact of the intervention by abstracting data at subsequent time points. RESULTS We evaluated potential causes for the low OQS and developed a plan to improve it over time by educating oncologists at our hospital on the importance of improving collection of measures and highlighting the goal of applying for QOPI certification. We conducted seven plan-do-study-act cycles and evaluated the scores at seven subsequent data abstraction time points from November 2021 to December 2022, reviewing 404 patients (199 BR; 114 CRC; 91 NSCLC). All measures were improved. Four months after the intervention, OQS surpassed the quality threshold and was maintained for 10 months until the end of the study (range, 78-87% for QCP Track measures; 78-86% for combined measures). CONCLUSIONS We developed an easy-to-implement intervention that achieved a fast improvement in OQS, enabling our Medical Oncology Department to aim for QOPI certification.
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Affiliation(s)
| | | | - Beatriz Alonso de Castro
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Sofía Silva Díaz
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Iria Parajó Vázquez
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
| | | | - Rafael López López
- Fundación ECO, Madrid, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosario García Campelo
- Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- A Coruña Biomedical Research Institute, A Coruña, Spain
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3
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O'Mahony D, Pinto CF, Orem J, Mcleod M, Aggarwal A, Gralow JR. Impact of Medical Oncology-Focused Quality Programs on Cancer Care Around the World. Am Soc Clin Oncol Educ Book 2024; 44:e432102. [PMID: 38870439 DOI: 10.1200/edbk_432102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Quality cancer care is efficient, accessible, coordinated, and evidence-based. Recognizing the necessary key components, development of pathways and guidelines to incorporate these key domains, and finally respectful adaptation to cultural differences can ensure that cancer care globally is of the highest quality. This quality care should be judged not only on how it optimizes health outcomes for patients, but also its impact on the care providers and the global community.
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Affiliation(s)
| | | | | | - Megan Mcleod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Ajay Aggarwal
- London School of Hygiene and Tropical Medicine/Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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4
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Banks LC, Kapphahn K, Das M, Patel MI. Randomized Trial of a Volunteer-Led Symptom Assessment Intervention on Documentation, Patient-Reported Outcomes, and Health Care Use Among Veterans With Lung Cancer. JCO Oncol Pract 2024; 20:419-428. [PMID: 38207246 DOI: 10.1200/op.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/03/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Identification and documentation of Veterans' symptoms are crucial for optimal lung cancer care delivery. The objective of this study was to determine whether a volunteer-led proactive telephone symptom assessment intervention could improve comprehensive symptom documentation. METHODS Veterans with lung cancer were randomly assigned to usual care (control group) or usual care with proactive symptom assessment in which a peer volunteer made weekly phone calls to assess patient symptoms under nurse practitioner supervision. The primary outcome was oncologist documentation of symptoms in the electronic health record at all clinical visits within 6 months after enrollment. Secondary outcomes included patient satisfaction with decision, patient activation, health-related quality of life (HRQOL), and symptom burden, measured at baseline, and 3, 6, and 9 months after enrollment, and acute care use within 9 months after enrollment. RESULTS Among 60 Veterans randomly assigned, median (range) age was 70.2 (50-86) years; 57 (95.0%) were male. More intervention participants had oncologist documentation of symptoms than control group participants (24 [77.4%] v seven [24.1%], respectively; odds ratio, 16.46 [95% CI, 4.58 to 59.16]). Intervention group participants had greater improvements over time in HRQOL (expected mean difference, 25.3 [95% CI, 15.00 to 35.70]) and patient activation (expected mean difference, 13.6 [95% CI, 3.79 to 23.39]), lower symptom burden (expected mean difference, -6.39 [95% CI, -15.21 to -2.46]), lower rates of emergency room visits (incidence rate ratio, 0.48 [95% CI, 0.30 to 0.75]), and hospitalizations (incidence rate ratio, 0.47 [95% CI, 0.28 to 0.77]) than control group participants. CONCLUSION This symptom assessment intervention is an effective strategy for Veterans with lung cancer.
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Affiliation(s)
| | - Kris Kapphahn
- Quantitative Sciences Unit, Stanford School of Medicine, Stanford, CA
| | - Millie Das
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
| | - Manali I Patel
- Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA
- Division of Oncology, Stanford School of Medicine, Stanford, CA
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5
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Kara P, Valentin JB, Mainz J, Johnsen SP. Composite measures of quality of health care: Evidence mapping of methodology and reporting. PLoS One 2022; 17:e0268320. [PMID: 35552561 PMCID: PMC9098058 DOI: 10.1371/journal.pone.0268320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators. Objective To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications. Methods We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s). Results A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure. Conclusion Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low. Discussion Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.
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Affiliation(s)
- Pinar Kara
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- * E-mail:
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department for Community Mental Health, University of Haifa, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Lewis S, Pandey S, Salins N, Deodhar J, Patil V, Gupta T, Laskar SG, Budrukkar A, Murthy V, Joshi A, Prabhash K, Nair S, Chaturvedi P, Noronha V, Agarwal JP. Distress Screening in Head and Neck Cancer Patients Planned for Cancer-Directed Radiotherapy. Laryngoscope 2021; 131:2023-2029. [PMID: 33720420 DOI: 10.1002/lary.29491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE/HYPOTHESIS To estimate the prevalence of baseline clinically significant distress (distress score ≥ 4) in head and neck cancer patients planned and treated with radical intent radiotherapy using the National Comprehensive Cancer Network Distress Thermometer (DT) and assess factors predictive of distress. STUDY DESIGN Cross-sectional study. METHODS This was a cross-sectional study evaluating distress in 600 head and neck cancer patients undergoing radiation therapy. The DT was used to screen patients for distress at baseline before radiotherapy. RESULTS The median distress score of the entire cohort was 4 interquartile range (IQR) (IQR: 3-5), and 340 patients (56.7%) had clinically significant distress. On univariate analysis, the causal factors predictive of distress were low socioeconomic status (P = .04), presence of proliferative growth at presentation (P = .008), site of the tumor (oral cavity, P = .02), comorbidity (P = .04), and presence of Ryle's tube or tracheostomy tube at baseline (P = .01). Low socioeconomic status was significant (P = .04) on multivariate analysis for high levels of distress. CONCLUSIONS Among head and neck cancer patients, 56% of patients had clinically significant baseline distress, and patients with low socioeconomic status had high distress. There is a need for interventions to mitigate distress. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2023-2029, 2021.
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Affiliation(s)
- Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Saket Pandey
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Salins
- Department of Palliative Medicine and supportive care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudhir Nair
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Rehman H, Kalra A, Kochar A, Uberoi AS, Bhatt DL, Samad Z, Virani SS. Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts. Indian Heart J 2020; 72:337-344. [PMID: 33189191 PMCID: PMC7670271 DOI: 10.1016/j.ihj.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQIP) provides valuable data on outpatient CVD quality of care. Collaborative efforts between health professionals are needed to assess further gaps in knowledge and policy makers to utilize new and existing data to drive policy-making.
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Affiliation(s)
- Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ajar Kochar
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Angad S Uberoi
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Zainab Samad
- Department of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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8
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Vos EL, Koppert LB, Jager A, Vrancken Peeters MJTFD, Siesling S, Lingsma HF. From Multiple Quality Indicators of Breast Cancer Care Toward Hospital Variation of a Summary Measure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1200-1209. [PMID: 32940238 DOI: 10.1016/j.jval.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To improve quality in breast cancer care, large numbers of quality indicators are collected per hospital, but benchmarking remains complex. We aimed to assess the validity of indicators, develop a textbook outcome summary measure, and compare case-mix adjusted hospital performance. METHODS From a nationwide population-based registry, all 79 690 nonmetastatic breast cancer patients surgically treated between 2011 and 2016 in 91 hospitals in The Netherlands were included. Twenty-one indicators were calculated and their construct validity tested by Spearman's rho. Between-hospital variation was expressed by interquartile range (IQR), and all valid indicators were included in the summary measure. Standardized scores (observed/expected based on case mix) were calculated as above (>100) or below (<100) expected. The textbook outcome was presented as a continuous and all-or-none score. RESULTS The size of between-hospital variation varied between indicators. Sixteen (76%) of 21 quality indicators showed construct validity, and 13 were included in the summary measure after excluding redundant indicators that showed collinearity with others owing to strong construct validity. The median all-or-none textbook outcome score was 49% (IQR 42%-54%) before and 49% (IQR 48%-51%) after case-mix adjustment. From the total of 91 hospitals, 3 hospitals were positive (3%) and 9 (10%) were negative outliers. CONCLUSIONS The textbook outcome summary measure showed discriminative ability when hospital performance was presented as an all-or-none score. Although indicator scores and outlier hospitals should always be interpreted cautiously, the summary measure presented here has the potential to improve Dutch breast cancer quality indicator efforts and could be implemented to further test its validity, feasibility, and usefulness.
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Affiliation(s)
- Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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9
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Hernandez-Boussard T, Blayney DW, Brooks JD. Leveraging Digital Data to Inform and Improve Quality Cancer Care. Cancer Epidemiol Biomarkers Prev 2020; 29:816-822. [PMID: 32066619 DOI: 10.1158/1055-9965.epi-19-0873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Efficient capture of routine clinical care and patient outcomes is needed at a population-level, as is evidence on important treatment-related side effects and their effect on well-being and clinical outcomes. The increasing availability of electronic health records (EHR) offers new opportunities to generate population-level patient-centered evidence on oncologic care that can better guide treatment decisions and patient-valued care. METHODS This study includes patients seeking care at an academic medical center, 2008 to 2018. Digital data sources are combined to address missingness, inaccuracy, and noise common to EHR data. Clinical concepts were identified and extracted from EHR unstructured data using natural language processing (NLP) and machine/deep learning techniques. All models are trained, tested, and validated on independent data samples using standard metrics. RESULTS We provide use cases for using EHR data to assess guideline adherence and quality measurements among patients with cancer. Pretreatment assessment was evaluated by guideline adherence and quality metrics for cancer staging metrics. Our studies in perioperative quality focused on medications administered and guideline adherence. Patient outcomes included treatment-related side effects and patient-reported outcomes. CONCLUSIONS Advanced technologies applied to EHRs present opportunities to advance population-level quality assessment, to learn from routinely collected clinical data for personalized treatment guidelines, and to augment epidemiologic and population health studies. The effective use of digital data can inform patient-valued care, quality initiatives, and policy guidelines. IMPACT A comprehensive set of health data analyzed with advanced technologies results in a unique resource that facilitates wide-ranging, innovative, and impactful research on prostate cancer. This work demonstrates new ways to use the EHRs and technology to advance epidemiologic studies and benefit oncologic care.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Affiliation(s)
- Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, California. .,Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Douglas W Blayney
- Department of Medicine, Stanford University, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - James D Brooks
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California.,Department of Urology, Stanford University School of Medicine, Stanford, California
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10
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Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France. PLoS One 2019; 14:e0224275. [PMID: 31644603 PMCID: PMC6808419 DOI: 10.1371/journal.pone.0224275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 12/09/2022] Open
Abstract
Background The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in “real-life” situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France. Methods 1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging. Results The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment. Conclusion This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.
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11
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Riba MB, Donovan KA, Andersen B, Braun II, Breitbart WS, Brewer BW, Buchmann LO, Clark MM, Collins M, Corbett C, Fleishman S, Garcia S, Greenberg DB, Handzo RGF, Hoofring L, Huang CH, Lally R, Martin S, McGuffey L, Mitchell W, Morrison LJ, Pailler M, Palesh O, Parnes F, Pazar JP, Ralston L, Salman J, Shannon-Dudley MM, Valentine AD, McMillian NR, Darlow SD. Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:1229-1249. [PMID: 31590149 PMCID: PMC6907687 DOI: 10.6004/jnccn.2019.0048] [Citation(s) in RCA: 348] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Distress is defined in the NCCN Guidelines for Distress Management as a multifactorial, unpleasant experience of a psychologic (ie, cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Early evaluation and screening for distress leads to early and timely management of psychologic distress, which in turn improves medical management. The panel for the Distress Management Guidelines recently added a new principles section including guidance on implementation of standards of psychosocial care for patients with cancer.
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Affiliation(s)
| | | | - Barbara Andersen
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - IIana Braun
- Dana-Farber/Brigham and Women's Cancer Center
| | | | | | | | | | | | | | | | - Sofia Garcia
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Laura Hoofring
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | | | | | - Janice P Pazar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Laurel Ralston
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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12
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Shulman LN, Browner AE, Palis BE, Mallin K, Kakade S, Carp N, McCabe R, Winchester D, Wong SL, McKellar DP. Compliance with Cancer Quality Measures Over Time and Their Association with Survival Outcomes: The Commission on Cancer's Experience with the Quality Measure Requiring at Least 12 Regional Lymph Nodes to be Removed and Analyzed with Colon Cancer Resections. Ann Surg Oncol 2019; 26:1613-1621. [PMID: 30927195 DOI: 10.1245/s10434-019-07323-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many quality measures in cancer care are process measures. The rates of compliance for these measures over time have not been well described, and the relationships between measure compliance and survival are not well understood. METHODS The National Cancer Database, representing cancer registry data from approximately 1500 Commission on Cancer (CoC) cancer programs, was queried to determine the rates of compliance, with the CoC's colon cancer quality measure requiring 12 regional lymph nodes be removed at resection. Data were assessed in 2003, before the measure was reported to programs, through 2015. Measure compliance and risk-adjusted survival were examined by hospital type. RESULTS From 2003 to 2015, 544,018 cases of colon cancer were analyzed for number of nodes removed. In 2003, compliance was 52.8% and National Cancer Institute (NCI) centers had the highest compliance rate (69.0%), followed by academic cancer centers (61.9%), comprehensive community hospitals (50.9%), and community hospitals (44.0%). Between 2003 and 2015, compliance improved for all hospital types, although differences remained. Risk-adjusted survival in 2009 was better at NCI centers [hazard ratio (HR) 0.76] than at academic cancer centers (HR 0.90), which had better survivals than comprehensive community programs (HR 0.93) when compared with patients treated at community hospitals. CONCLUSION After introduction of this quality measure, performance at CoC-accredited hospitals improved over the subsequent 13 years, and survival by hospital type paralleled measure compliance by hospital type. This demonstrated measurement may be associated with improvements in performance, and that there are differences in performance and outcome by hospital type.
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Affiliation(s)
- Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. .,American College of Surgeons, Commission on Cancer, Chicago, IL, USA.
| | - Amanda E Browner
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA
| | - Bryan E Palis
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA
| | - Katherine Mallin
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA
| | | | - Ned Carp
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA.,Lankenau Medical Center, Wynnewood, PA, USA
| | - Ryan McCabe
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA
| | - David Winchester
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA
| | - Sandra L Wong
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA.,Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Daniel P McKellar
- American College of Surgeons, Commission on Cancer, Chicago, IL, USA.,Wright State University, Dayton, OH, USA
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13
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Barni S, Venturini M, Molino A, Donadio M, Rizzoli S, Maiello E, Gori S. Importance of adherence to guidelines in breast cancer clinical practice. The Italian experience (AIOM). TUMORI JOURNAL 2018; 97:559-63. [DOI: 10.1177/030089161109700503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Project RIGHT (Research for the Identification of the most effective and hIGHly accepted clinical guidelines for cancer Treatment) is promoted by the Italian Association of Medical Oncology (AIOM) to evaluate the concordance between AIOM breast cancer guidelines and clinical practice in Italy. In RIGHT-1, feasibility and the appropriateness of indicators were assessed in patients with early breast cancer. RIGHT-2 evaluated the compliance with guidelines in a nationwide program. Methods Thirty-five Italian centers participated in the RIGHT-2 survey. Ten indicators were evaluated to verify an agreement between 2005 AIOM breast cancer guidelines and practice. Patients with clinical stage I-II invasive breast cancer, age ≤70 years, who had their first visit at the oncology center between October 2005 and November 2006 were included. Results In RIGHT-2, ≥90% adherence for the diagnosis indicator and three therapy indicators were observed. The lowest degree of compliance (0%) was observed for the follow-up indicator in asymptomatic patients. Conclusions In RIGHT-2, compliance to the 2005 AIOM breast cancer guidelines was 64%. When the follow-up indicator was eliminated, overall adherence to AIOM guidelines was 71%. The results highlight the need to continue improving the already good standards of breast cancer care.
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Affiliation(s)
- Sandro Barni
- Oncologia Medica, Azienda Ospedaliera
Treviglio-Caravaggio, Treviglio, Bergamo
| | | | | | | | | | | | - Stefania Gori
- Oncologia Medica, Azienda Ospedaliera,
Perugia, Italy
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14
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Shulman LN, Palis BE, McCabe R, Mallin K, Loomis A, Winchester D, McKellar D. Survival As a Quality Metric of Cancer Care: Use of the National Cancer Data Base to Assess Hospital Performance. J Oncol Pract 2018; 14:e59-e72. [DOI: 10.1200/jop.2016.020446] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Survival is considered an important indicator of the quality of cancer care, but the validity of different methodologies to measure comparative survival rates is less well understood. We explored whether the National Cancer Data Base (NCDB) could serve as a source of unadjusted and risk-adjusted cancer survival data and whether these data could be used as quality indicators for individual hospitals or in the aggregate by hospital type. Methods: The NCDB, an aggregate of > 1,500 hospital cancer registries, was queried to analyze unadjusted and risk-adjusted hazards of death for patients with stage III breast cancer (n = 116,787) and stage IIIB or IV non–small-cell lung cancer (n = 252,392). Data were analyzed at the individual hospital level and by hospital type. Results: At the hospital level, after risk adjustment, few hospitals had comparative risk-adjusted survival rates that were statistically better or worse. By hospital type, National Cancer Institute–designated comprehensive cancer centers had risk-adjusted survival ratios that were statistically significantly better than those of academic cancer centers and community hospitals. Conclusion: Using the NCDB as the data source, survival rates for patients with stage III breast cancer and stage IIIB or IV non–small-cell lung cancer were statistically better at National Cancer Institute–designated comprehensive cancer centers when compared with other hospital types. Compared with academic hospitals, risk-adjusted survival was lower in community hospitals. At the individual hospital level, after risk adjustment, few hospitals were shown to have statistically better or worse survival, suggesting that, using NCDB data, survival may not be a good metric to determine relative quality of cancer care at this level.
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Affiliation(s)
- Lawrence N. Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - Bryan E. Palis
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - Ryan McCabe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - Kathy Mallin
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - Ashley Loomis
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - David Winchester
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
| | - Daniel McKellar
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Commission on Cancer, Chicago, IL; and Wright State University, Dayton, OH
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15
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Mathew A, Achkar T, Abberbock S, Sandhu GS, Jacob ME, Villgran VD, Rosenzweig MQ, Puhalla S, Brufsky AM. Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. Breast J 2017; 23:718-722. [PMID: 28845536 DOI: 10.1111/tbj.12905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/01/2022]
Abstract
Cessation of chemotherapy in the last few weeks of life could be an important quality-of-care benchmark. Proportion of metastatic breast cancer patients who receive end-of-life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010, and September 30, 2014, was conducted. End-of-life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2) and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison with non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end-of-life chemotherapy use. Prevalence of the use of end-of-life chemotherapy in our cohort was higher than previously described. More end-of-life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end-of-life discussions may be targeted to such patients.
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Affiliation(s)
- Aju Mathew
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
| | - Tala Achkar
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Shira Abberbock
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | | | | | - Vipin Das Villgran
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | | | - Shannon Puhalla
- Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- University of Pittsburgh Magee Women's Hospital, Pittsburgh, PA, USA
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16
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Caution is required in the implementation of 90-day mortality indicators for radiotherapy in a curative setting: A retrospective population-based analysis of over 16,000 episodes. Radiother Oncol 2017; 125:140-146. [PMID: 28844331 PMCID: PMC5648077 DOI: 10.1016/j.radonc.2017.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/03/2022]
Abstract
Background 90-day mortality (90 DM) has been proposed as a clinical indicator in radiotherapy delivered in a curative setting. No large scale assessment has been made. Its value in allowing robust comparisons between centres and facilitating service improvement is unknown. Methods All radiotherapy treatments delivered in a curative setting over seven years were extracted from the local electronic health record and linked to cancer registry data. 90 DM rates were assessed and factors associated with this outcome were investigated using logistic regression. Cause of death was identified retrospectively further characterising the cause of 90 DM. Results Overall 90 DM was 1.25%. Levels varied widely with diagnosis (0.20–5.45%). Age (OR 1.066, 1.043–1.073), year of treatment (OR 0.900, 0.841–0.969) and diagnosis were significantly associated with 90 DM on multi-variable logistic regression. Cause of death varied with diagnosis; 50.0% post-operative in rectal cancer, 40.4% treatment-related in head and neck cancer, 59.4% disease progression in lung cancer. Conclusion Despite the drive to report centre level comparative outcomes, this study demonstrates that 90 DM cannot be adopted routinely as a clinical indicator due to significant population heterogeneity and low event rates. Further national investigation is needed to develop a meaningful robust indicator to deliver appropriate comparisons and drive improvements in care.
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17
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Enright KA, Taback N, Powis ML, Gonzalez A, Yun L, Sutradhar R, Trudeau ME, Booth CM, Krzyzanowska MK. Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data. J Clin Oncol 2017; 35:3207-3214. [PMID: 28682683 DOI: 10.1200/jco.2016.70.7950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Routine evaluation of quality measures (QMs) can drive improvement in cancer systems by highlighting gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact at the population level. We developed an approach that uses both variation in performance and number of patients affected by the QM to set priorities for improving the quality of systemic therapy for women with early-stage breast cancer (EBC). Patients and Methods Patients with EBC diagnosed from 2006 to 2010 in Ontario, Canada, were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. Individual QMs within a panel of 15 QMs previously developed to assess the quality of systemic therapy across four domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance (using interquartile range) and the number of patients who were affected; then the two rankings were averaged for a summative priority ranking. Results We identified 28,427 patients with EBC who were treated at 84 institutions. The use of computerized physician electronic order entry for chemotherapy, emergency room visits or hospitalizations during chemotherapy, and timely receipt of chemotherapy were identified as the QMs that had the largest potential to improve quality of care at a system level within this cohort. Conclusion A simple ranking system based on interinstitutional variation in performance and patient volume can be used to identify high-priority areas for quality improvement from a population perspective. This approach is generalizable to other health care systems that use QMs to drive improvement.
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Affiliation(s)
- Katherine A Enright
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Nathan Taback
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Melanie Lynn Powis
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Alejandro Gonzalez
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Lingsong Yun
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Rinku Sutradhar
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Maureen E Trudeau
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Monika K Krzyzanowska
- Katherine A. Enright, Trillium Health Partners-Credit Valley Hospital, Mississauga; Katherine A. Enright, Nathan Taback, Rinku Sutradhar, Maureen E. Trudeau, and Monika K. Krzyzanowska, University of Toronto; Melanie Lynn Powis and Monika K. Krzyzanowska, Princess Margaret Cancer Centre; Alejandro Gonzalez, Lingsong Yun, Rinku Sutradhar, and Monika K. Krzyzanowska, Institute for Clinical Evaluative Sciences; Maureen E. Trudeau, Sunnybrook Odette Cancer Centre, Toronto; and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
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An Assessment of the Quality Oncology Practice Initiative: Lessons Learned From a Detailed Assessment of a Well-Established Profession-Based Performance Measurement Program. J Healthc Qual 2017; 39:e49-e58. [DOI: 10.1097/jhq.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fife CE, Eckert KA. Harnessing electronic healthcare data for wound care research: Standards for reporting observational registry data obtained directly from electronic health records. Wound Repair Regen 2017; 25:192-209. [PMID: 28370796 DOI: 10.1111/wrr.12523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/31/2017] [Accepted: 03/04/2017] [Indexed: 11/26/2022]
Abstract
The United States Food and Drug Administration will consider the expansion of coverage indications for some drugs and devices based on real-world data. Real-world data accrual in patient registries has historically been via manual data entry from the medical chart at a time distant from patient care, which is fraught with systematic error. The efficient automated transmission of data directly from electronic health records is replacing this labor-intensive paradigm. However, real-world data collection is unfamiliar. The potential sources of bias arising from the source of data and data accrual, documentation, and aggregation have not been well defined. Furthermore, the technological aspects of data acquisition and transmission are less transparent. We explore opportunities for harnessing direct-from-electronic health record registry reporting and propose the ABCs of Registries (Analysis of Bias Criteria of Registries), which are an evaluation framework for publications to minimize potential bias of real-world data obtained directly from an electronic health record method. These standards are based on a point-of-care data documentation process using a common definitional framework and data dictionaries. By way of example, we describe a wound registry obtained directly from electronic health records. This qualified clinical data registry minimizes bias by ensuring complete and accurate point-of-care data capture, standardizes usual care linked to quality reporting, and prevents post-hoc vetting of outcomes. The resulting data are of high quality and integrity and can be used for comparative effectiveness research in wound care. In this way, the effort needed to succeed with the Quality Payment Program is leveraged to obtain the real-world data needed for comparative effectiveness research.
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Affiliation(s)
- Caroline E Fife
- Baylor College of Medicine, Houston, TX.,The US Wound Registry, The Woodlands, TX
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Stuver SO, McNiff K, Fraile B, Odejide O, Abel GA, Dodek A, Jacobson JO. Novel Data Sharing Between a Comprehensive Cancer Center and a Private Payer to Better Understand Care at the End of Life. J Pain Symptom Manage 2016; 52:161-9. [PMID: 27033156 DOI: 10.1016/j.jpainsymman.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/01/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Understanding end-of-life (EOL) care patterns is a prerequisite to improving the experience for cancer patients. EOL measures endorsed by the National Quality Forum (NQF) have been examined in older patients using Medicare claims. OBJECTIVES To evaluate EOL care for patients treated at a comprehensive cancer center, using private payer claims data. METHODS A retrospective cohort study was conducted of Dana-Farber Cancer Institute (DFCI) patients who died between July 2010 and December 2012, and were insured by Blue Cross Blue Shield of Massachusetts. Primary data sources included Blue Cross Blue Shield of Massachusetts claims information and DFCI administrative data. We assessed NQF-endorsed measures of EOL care related to emergency department visits, hospitalizations, and intensive care unit admissions in the last 30 days, chemotherapy in the last 14 days, hospice stay, and death in an acute care setting. Patterns of care by cancer type and service location were determined. RESULTS Among 674 patients (mean age 58 years), event rates for NQF-endorsed EOL measures were similar to those reported using Medicare claims. Decedents with hematologic malignancies received significantly more intensive care and were less likely to have enrolled in hospice, compared to decedents with solid tumors. Thirty to 45% of EOL events occurred outside of DFCI and its affiliated hospitals. CONCLUSION Data sharing between a private payer and a large cancer center proved feasible and informative. High rates of hospital service use outside of our sites of care were unexpected. The findings suggest opportunities to better manage care at the end of life.
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Affiliation(s)
- Sherri O Stuver
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Boston University School of Public Health, Boston, Massachusetts, USA.
| | - Kristen McNiff
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Bélen Fraile
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Oreofe Odejide
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory A Abel
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anton Dodek
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA
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Riblet NBV. Transitioning to Academic Quality-Improvement Work Within the Field of Oncology: Opportunities and Challenges. J Oncol Pract 2016; 12:855-858. [PMID: 27328794 DOI: 10.1200/jop.2016.013193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Natalie B V Riblet
- Veterans Affairs Medical Center, White River Junction, VT; Geisel School of Medicine at Dartmouth, Hanover; and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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Young A, Marshall E, Krzyzanowska M, Robinson B, Brown S, Collinson F, Seligmann J, Abbas A, Rees A, Swinson D, Neville-Webbe H, Selby P. Responding to Acute Care Needs of Patients With Cancer: Recent Trends Across Continents. Oncologist 2016; 21:301-7. [PMID: 26921289 PMCID: PMC4786347 DOI: 10.1634/theoncologist.2014-0341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/25/2015] [Indexed: 12/28/2022] Open
Abstract
Remarkable progress has been made over the past decade in cancer medicine. Personalized medicine, driven by biomarker predictive factors, novel biotherapy, novel imaging, and molecular targeted therapeutics, has improved outcomes. Cancer is becoming a chronic disease rather than a fatal disease for many patients. However, despite this progress, there is much work to do if patients are to receive continuous high-quality care in the appropriate place, at the appropriate time, and with the right specialized expert oversight. Unfortunately, the rapid expansion of therapeutic options has also generated an ever-increasing burden of emergency care and encroaches into end-of-life palliative care. Emergency presentation is a common consequence of cancer and of cancer treatment complications. It represents an important proportion of new presentations of previously undiagnosed malignancy. In the U.K. alone, 20%-25% of new cancer diagnoses are made following an initial presentation to the hospital emergency department, with a greater proportion in patients older than 70 years. This late presentation accounts for poor survival outcomes and is often associated with poor patient experience and poorly coordinated care. The recent development of acute oncology services in the U.K. aims to improve patient safety, quality of care, and the coordination of care for all patients with cancer who require emergency access to care, irrespective of the place of care and admission route. Furthermore, prompt management coordinated by expert teams and access to protocol-driven pathways have the potential to improve patient experience and drive efficiency when services are fully established. The challenge to leaders of acute oncology services is to develop bespoke models of care, appropriate to local services, but with an opportunity for acute oncology teams to engage cancer care strategies and influence cancer care and delivery in the future. This will aid the integration of highly specialized cancer treatment with high-quality care close to home and help avoid hospital admission.
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Affiliation(s)
- Alison Young
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Ernie Marshall
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | | | | | - Sean Brown
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | - Fiona Collinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Jennifer Seligmann
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Afroze Abbas
- Diabetes Center, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Adrian Rees
- NHS Leeds West Clinical Commissioning Group, Leeds, United Kingdom
| | - Daniel Swinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | | | - Peter Selby
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom University of Leeds, Leeds, United Kingdom
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23
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Ganz PA, Hassett MJ, Miller DC. Challenges and Opportunities in Delivering High-Quality Cancer Care: A 2016 Update. Am Soc Clin Oncol Educ Book 2016; 35:e294-e300. [PMID: 27249735 DOI: 10.1200/edbk_159303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Herein, both the rationale and scope of current initiatives aimed at improving the quality of cancer care delivery in the United States are described. First, we discuss a recent report from the Institute of Medicine that issued a strong call for both the development of quality measures in oncology and implementation of a learning health care system in which data and experience from clinical practice can inform continuous improvements in cancer care. Second, we review the multiple, diverse initiatives that are underway to identify, test, and validate quality measures for the entire spectrum of cancer care. Finally, we discuss regional quality improvement collaboratives as one successful approach to creating a cycle of quality measurement, identification of best practices, and implementation of changes in practice patterns that ultimately yield improved care and outcomes for patients with cancer.
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Affiliation(s)
- Patricia A Ganz
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - Michael J Hassett
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
| | - David C Miller
- From the Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA; Department of Medicine, Harvard Medical School, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Dow Division of Health Services Research, Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI
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24
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Tapela NM, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye FR, Hirschhorn LR, Muhimpundu MA, Balinda JP, Amoroso C, Wagner CM, Binagwaho A, Shulman LN. Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery. J Clin Oncol 2015; 34:43-52. [PMID: 26578617 DOI: 10.1200/jco.2015.61.7738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. METHODS The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. RESULTS Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. CONCLUSION Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.
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Affiliation(s)
- Neo M Tapela
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA.
| | - Tharcisse Mpunga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Nadine Karema
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Ignace Nzayisenga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Temidayo Fadelu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Frank R Uwizeye
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lisa R Hirschhorn
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Marie Aimee Muhimpundu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Jean Paul Balinda
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Cheryl Amoroso
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Claire M Wagner
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Agnes Binagwaho
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lawrence N Shulman
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
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McNiff KK, Jacobson JO. Aiming for ideal care: a proposed framework for cancer quality improvement. J Oncol Pract 2015; 10:339-44. [PMID: 25398953 DOI: 10.1200/jop.2014.001305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors review the advances made in oncology over the past 50 years and describe methods for closing the gap in care quality.
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26
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Affiliation(s)
- Paul B. Jacobsen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, Florida
| | - Morgan Lee
- Department of Psychology, University of South Florida, Tampa, Florida
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27
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Warner JL, Levy MA, Neuss MN, Warner JL, Levy MA, Neuss MN. ReCAP: Feasibility and Accuracy of Extracting Cancer Stage Information From Narrative Electronic Health Record Data. J Oncol Pract 2015; 12:157-8; e169-7. [PMID: 26306621 DOI: 10.1200/jop.2015.004622] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer stage, one of the most important prognostic factors for cancer-specific survival, is often documented in narrative form in electronic health records (EHRs). Such documentation results in tedious and time-consuming abstraction efforts by tumor registrars and other secondary users. This information may be amenable to extraction by automated methods. METHODS We developed a natural language processing algorithm to extract stage statements from machine-readable EHR documents, including automated rules to choose the most likely stage when discordance was present in the EHR. These methods were developed in a training set of patients with lung cancer, independently validated in a test set of patients with lung cancer, and compared with the gold standard of Vanderbilt Cancer Registry–determined stage (when available). RESULTS In the combined data set of 2,323 patients (training set, n = 1,103; validation set, n = 1,220), 751,880 documents were analyzed. A stage statement was extracted from 2,239 (98.6%) patient EHRs (median, 24 documents per patient). Stage discordance was common, affecting 83.6% of these EHRs. Nevertheless, algorithmically derived stage accuracy was high in the validation set (κ = 0.906; 95% CI, 0.873 to 0.939), when including notes generated within 14 weeks from diagnosis. CONCLUSION Accurate stage determination can be achieved through automated methods applied to narrative text, despite the frequent presence of discordance in such data. Our results also indicate that stage can be automatically captured in a shorter timeframe than the 6-month window used by cancer registries, as early as 5 weeks from diagnosis. These methods may be generalizable to large narrative cancer data sets.
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Affiliation(s)
- Jeremy L Warner
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Mia A Levy
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Michael N Neuss
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jeremy L Warner
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Mia A Levy
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Michael N Neuss
- Vanderbilt University; and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Bao H, Yang F, Wang X, Su S, Liu D, Fu R, Zhang H, Liu M. Developing a set of quality indicators for breast cancer care in China. Int J Qual Health Care 2015; 27:291-6. [DOI: 10.1093/intqhc/mzv042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/13/2022] Open
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Spencer K, Morris E, Dugdale E, Newsham A, Sebag-Montefiore D, Turner R, Hall G, Crellin A. 30 day mortality in adult palliative radiotherapy--A retrospective population based study of 14,972 treatment episodes. Radiother Oncol 2015; 115:264-71. [PMID: 25861831 PMCID: PMC4504022 DOI: 10.1016/j.radonc.2015.03.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 11/25/2022]
Abstract
Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems.
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Affiliation(s)
- Katie Spencer
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
| | - Eva Morris
- Cancer Epidemiology Group, Section of Epidemiology and Biostatistics, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom
| | - Emma Dugdale
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom
| | - Alexander Newsham
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom
| | - David Sebag-Montefiore
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom
| | - Rob Turner
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom
| | - Geoff Hall
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom
| | - Adrian Crellin
- St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom
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30
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McFadyen C, Lankshear S, Divaris D, Berry M, Hunter A, Srigley J, Irish J. Physician level reporting of surgical and pathology performance indicators: a regional study to assess feasibility and impact on quality. Can J Surg 2015; 58:31-40. [PMID: 25427336 DOI: 10.1503/cjs.004314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels. METHODS Individual provider level reporting was implemented within a provincial health region involving 56 clinicians (general surgeons, surgical oncologists, urologists and pathologists). The 2 surgical pathology indicators chosen were colorectal cancer (CRC) lymph node retrieval rate and pT2 prostate cancer margin positivity rate. Surgical resections for all prostate and colorectal cancer performed between Jan. 1, 2011, and Mar. 30, 2012, were included. We used a pre- and postsurvey design to obtain physician perceptions and focus groups with program leadership to determine organizational impact. RESULTS Survey results showed that respondents felt the data provided in the reports were valid (67%), consistent with expectations (70%), maintained confidentiality (80%) and were not used in a punitive manner (77%). During the study period the pT2 prostate margin positivity rate decreased from 57.1% to 27.5%. For the CRC lymph node retrieval rate indicator, high baseline performance was maintained. CONCLUSION We developed a robust process for providing physicians with confidential, individualized surgical and pathology quality indicator reports. Our results reinforce the importance of individual physician feedback as a strategy for improving and sustaining quality in surgical and diagnostic oncology.
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Affiliation(s)
- Craig McFadyen
- Cancer Care Ontario, Toronto, Ont. and Trillium Health Partners, Mississauga, Ont
| | | | - Dimitrios Divaris
- Cancer Care Ontario, Toronto, Ont. and Grand River Hospital, Kitchener, Ont
| | | | | | | | - Jonathan Irish
- Cancer Care Ontario, and Princess Margaret Cancer Centre, Toronto, Ont
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Siegel RD, Castro KM, Eisenstein J, Stallings H, Hegedus PD, Bryant DM, Kadlubek PJ, Clauser SB. Quality improvement in the national cancer institute community cancer centers program: the quality oncology practice initiative experience. J Oncol Pract 2015; 11:e247-54. [PMID: 25538082 PMCID: PMC4371125 DOI: 10.1200/jop.2014.000703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. METHODS A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. RESULTS QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). CONCLUSION Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives.
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Affiliation(s)
- Robert D Siegel
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Kathleen M Castro
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Jana Eisenstein
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Holley Stallings
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Patricia D Hegedus
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Donna M Bryant
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Pam J Kadlubek
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
| | - Steven B Clauser
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT; National Cancer Institute, Bethesda, MD; Norton Cancer Institute, Louisville, KY; Gibbs Cancer Center-Spartanburg Healthcare System, Spartanburg, SC; Mary Bird Perkins-Our Lady of the Lake Cancer Center, Baton Rouge, LA; and American Society of Clinical Oncology, Alexandria, VA
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Wright JD, Tergas AI, Ananth CV, Burke WM, Chen L, Neugut AI, Richards CA, Hershman DL. Relationship between surgical oncologic outcomes and publically reported hospital quality and satisfaction measures. J Natl Cancer Inst 2015; 107:dju409. [PMID: 25618899 PMCID: PMC4565527 DOI: 10.1093/jnci/dju409] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/09/2014] [Accepted: 11/07/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hospital-level measures of patient satisfaction and quality are now reported publically by the Centers for Medicare and Medicaid Services. There are limited metrics specific to cancer patients. We examined whether publically reported hospital satisfaction and quality data were associated with surgical oncologic outcomes. METHODS The Nationwide Inpatient Sample was utilized to identify patients with solid tumors who underwent surgical resection in 2009 and 2010. The hospitals were linked to Hospital Compare, which collects data on patient satisfaction, perioperative quality, and 30-day mortality for medical conditions (pneumonia, myocardial infarction [MI], and congestive heart failure [CHF]). The risk-adjusted hospital-level rates of morbidity and mortality were calculated for each hospital and the means compared between the highest and lowest performing hospital quartiles and reported as absolute reduction in risk (ARR), the difference in risk of the outcome between the two groups. All statistical tests were two-sided. RESULTS A total of 63197 patients treated at 448 hospitals were identified. For patients at high vs low performing hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems scores, the ARR in perioperative morbidity was 3.1% (95% confidence interval [CI] = 0.4% to 5.7%, P = .02). Similarly, the ARR for mortality based on the same measure was -0.4% (95% CI = -1.5% to 0.6%, P = .40). High performance on perioperative quality measures resulted in an ARR of 0% to 2.2% for perioperative morbidity (P > .05 for all). Similarly, there was no statistically significant association between hospital-level mortality rates for MI (ARR = 0.7%, 95% CI = -1.0% to 2.5%), heart failure (ARR = 1.0%, 95% CI = -0.6% to 2.7%), or pneumonia (ARR = 1.6%, 95% CI = -0.3% to 3.5%) and complications for oncologic surgery patients. CONCLUSION Currently available measures of patient satisfaction and quality are poor predictors of outcomes for cancer patients undergoing surgery. Specific metrics for long-term oncologic outcomes and quality are needed.
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Affiliation(s)
- Jason D Wright
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH).
| | - Ana I Tergas
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - Cande V Ananth
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - William M Burke
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - Ling Chen
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - Alfred I Neugut
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - Catherine A Richards
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
| | - Dawn L Hershman
- Affiliations of authors: Department of Obstetrics and Gynecology (JDW, AIT, CVA, WMB, LC), Department of Medicine (AIN, DLH), and Herbert Irving Comprehensive Cancer Center (JDW, AIT, AIN, DLH, WMB), Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University (AIT, CVA, AIN, CAR, DLH)
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Cooley ME, Blonquist TM, Catalano PJ, Lobach DF, Halpenny B, McCorkle R, Johns EB, Braun IM, Rabin MS, Mataoui FZ, Finn K, Berry DL, Abrahm JL. Feasibility of using algorithm-based clinical decision support for symptom assessment and management in lung cancer. J Pain Symptom Manage 2015; 49:13-26. [PMID: 24880002 PMCID: PMC4621015 DOI: 10.1016/j.jpainsymman.2014.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 04/25/2014] [Accepted: 05/06/2014] [Indexed: 12/22/2022]
Abstract
CONTEXT Distressing symptoms interfere with the quality of life in patients with lung cancer. Algorithm-based clinical decision support (CDS) to improve evidence-based management of isolated symptoms seems promising, but no reports yet address multiple symptoms. OBJECTIVES This study examined the feasibility of CDS for a Symptom Assessment and Management Intervention targeting common symptoms in patients with lung cancer (SAMI-L) in ambulatory oncology. The study objectives were to evaluate completion and delivery rates of the SAMI-L report and clinician adherence to the algorithm-based recommendations. METHODS Patients completed a web-based symptom assessment and SAMI-L created tailored recommendations for symptom management. Completion of assessments and delivery of reports were recorded. Medical record review assessed clinician adherence to recommendations. Feasibility was defined as 75% or higher report completion and delivery rates and 80% or higher clinician adherence to recommendations. Descriptive statistics and generalized estimating equations were used for data analyses. RESULTS Symptom assessment completion was 84% (95% CI=81-87%). Delivery of completed reports was 90% (95% CI=86-93%). Depression (36%), pain (30%), and fatigue (18%) occurred most frequently, followed by anxiety (11%) and dyspnea (6%). On average, overall recommendation adherence was 57% (95% CI=52-62%) and was not dependent on the number of recommendations (P=0.45). Adherence was higher for anxiety (66%; 95% CI=55-77%), depression (64%; 95% CI=56-71%), pain (62%; 95% CI=52-72%), and dyspnea (51%; 95% CI=38-64%) than for fatigue (38%; 95% CI=28-47%). CONCLUSION The CDS systems, such as SAMI-L, have the potential to fill a gap in promoting evidence-based care.
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Affiliation(s)
- Mary E Cooley
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | | | | | | | | | | | - Ellis B Johns
- Virginia Commonwealth University Shenandoah Valley, Front Royal, Virginia, USA
| | - Ilana M Braun
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | - Donna L Berry
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Janet L Abrahm
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Blayney DW, McNiff K, Eisenberg PD, Gilmore T, Jacobsen PB, Jacobson JO, Kadlubek PJ, Neuss MN, Simone J. Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative. J Clin Oncol 2014; 32:3907-13. [DOI: 10.1200/jco.2014.56.8899] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Douglas W. Blayney
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | - Terry Gilmore
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Michael N. Neuss
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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Lim C, Cheung MC, Franco B, Dharmakulaseelan L, Chong E, Iyngarathasan A, Singh S. Quality Improvement: An Assessment of Participation and Attitudes of Medical Oncologists. J Oncol Pract 2014; 10:e408-14. [DOI: 10.1200/jop.2014.001515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canadian medical oncologists face limitations to participating in QI initiatives as a result of lack of time, publication resources, and knowledge about ongoing initiatives. Improving networking opportunities and prioritizing QI at the institutional level can address this need.
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Affiliation(s)
- Charles Lim
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Bryan Franco
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | | | - Evan Chong
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Amesha Iyngarathasan
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
| | - Simron Singh
- Sunnybrook Health Sciences Center, Odette Cancer Center, Toronto, Ontario, Canada
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36
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Laronga C, Gray JE, Siegel EM, Lee JH, Fulp WJ, Fletcher M, Schreiber F, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D, Malafa M, Jacobsen PB. Florida Initiative for Quality Cancer Care: improvements in breast cancer quality indicators during a 3-year interval. J Am Coll Surg 2014; 219:638-45.e1. [PMID: 25086813 DOI: 10.1016/j.jamcollsurg.2014.03.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 03/31/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Florida Initiative for Quality Cancer Care (FIQCC), composed of 11 practice sites across Florida, conducted its initial evaluation of adherence to breast cancer quality of care indicators (QCI) in 2006, with feedback provided to encourage quality improvement efforts at participating sites. In this study, our objective was to reassess changes over time resulting from these efforts. STUDY DESIGN Quality care indicators were derived from the Quality Oncology Practice Initiative, the National Comprehensive Cancer Network, the American College of Surgeons, and expert panel consensus. Medical records were reviewed for breast cancer patients first seen by medical oncologists in 2009 at the FIQCC sites, using the same performance indicators as in 2006. Statistical comparisons of 2006 vs 2009 data across sites were made by Pearson chi-square exact test using Monte Carlo estimation. RESULTS Charts of 602 patients in 2006 and 636 patients in 2009 were compared. Performance on medical oncology QCI improved over time for documentation of clinical trial participation discussion (p = 0.001), documentation of consent for chemotherapy (p = 0.047), definitive surgery done after neoadjuvant chemotherapy (p = 0.017), and planned dose of chemotherapy consistent with published regimens (p = 0.02). Improvements in surgical QCI were seen for documentation of specimen orientation (p < 0.001), inking of margins (p < 0.0001), and performance of sentinel lymph node biopsy (p = 0.035). CONCLUSIONS The 2006 FIQCC study identified several medical and surgical oncology QCI improvement needs. Quality improvement efforts resulted in better performance for numerous metrics, therefore speaking to the benefits of reassessment of adherence to performance indicators to guide QCI efforts.
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Affiliation(s)
| | | | | | | | | | | | - Fred Schreiber
- Center for Cancer Care & Research/Watson Clinic, Lakeland, FL
| | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine & Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
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Kamal AH, Gradison M, Maguire JM, Taylor D, Abernethy AP. Quality measures for palliative care in patients with cancer: a systematic review. J Oncol Pract 2014; 10:281-7. [PMID: 24917264 DOI: 10.1200/jop.2013.001212] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Quality assessment is a critical component of determining the value of medical services, including palliative care. Characterization of the current portfolio of measures that assess the quality of palliative care delivered in oncology is necessary to identify gaps and inform future measure development. METHODS We performed a systematic review of MEDLINE/PubMed and the gray literature for quality measures relevant to palliative care. Measures were categorized into National Quality Forum domains and reviewed for methodology of development and content. Measures were additionally analyzed to draw summative conclusions on scope and span. RESULTS Two hundred eighty-four quality measures within 13 measure sets were identified. The most common domains for measure content were Physical Aspects of Care (35%) and Structure and Processes of Care (22%). Of symptom-related measures, pain (36%) and dyspnea (26%) were the most commonly addressed. Spiritual (4%) and Cultural (1%) Aspects of Care were least represented domains. Generally, measures addressed processes of care, did not delineate benchmarks for success, and often did not specify intended interventions to address unmet needs. This was most evident regarding issues of psychosocial and spiritual assessment and management. CONCLUSION Within a large cohort of quality measures for palliative, care is often a focus on physical manifestations of disease and adverse effects of therapy; relatively little attention is given to the other aspects of suffering commonly observed among patients with advanced cancer, including psychological, social, and spiritual distress.
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Affiliation(s)
- Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Gradison
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Jennifer M Maguire
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Donald Taylor
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Amy P Abernethy
- Duke Cancer Institute, Duke University Medical Center; Duke Center for Learning Health Care, Duke Clinical Research Institute; Sanford School of Public Policy, Duke University, Durham; Division of Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC
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Hassett MJ, McNiff KK, Dicker AP, Gilligan T, Hendricks CB, Lennes I, Murray T, Krzyzanowska MK. High-Priority Topics for Cancer Quality Measure Development: Results of the 2012 American Society of Clinical Oncology Collaborative Cancer Measure Summit. J Oncol Pract 2014; 10:e160-6. [DOI: 10.1200/jop.2013.001240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Addressing the high-priority topics identified by this effort will help fill the gaps left by existing cancer quality measures, including care coordination and transitions, quality of life, safety, experience of care, and outcomes.
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Affiliation(s)
- Michael J. Hassett
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Kristen K. McNiff
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Adam P. Dicker
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Timothy Gilligan
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Carolyn B. Hendricks
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Inga Lennes
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Thomas Murray
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- Dana-Farber Cancer Institute; Harvard Medical School; Massachusetts General Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA; Thomas Jefferson University, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Center for Breast Health, Bethesda, MD; and Princess Margaret Hospital, Toronto, Ontario, Canada
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Spinks T, Ganz PA, Sledge GW, Levit L, Hayman JA, Eberlein TJ, Feeley TW. Delivering High-Quality Cancer Care: The Critical Role of Quality Measurement. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2014; 2:53-62. [PMID: 24839592 PMCID: PMC4021589 DOI: 10.1016/j.hjdsi.2013.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 1999, the Institute of Medicine (IOM) published Ensuring Quality Cancer Care, an influential report that described an ideal cancer care system and issued ten recommendations to address pervasive gaps in the understanding and delivery of quality cancer care. Despite generating much fervor, the report's recommendations-including two recommendations related to quality measurement-remain largely unfulfilled. Amidst continuing concerns regarding increasing costs and questionable quality of care, the IOM charged a new committee with revisiting the 1999 report and with reassessing national cancer care, with a focus on the aging US population. The committee identified high-quality patient-clinician relationships and interactions as central drivers of quality and attributed existing quality gaps, in part, to the nation's inability to measure and improve cancer care delivery in a systematic way. In 2013, the committee published its findings in Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which included two recommendations that emphasize coordinated, patient-centered quality measurement and information technology enhancements: Develop a national quality reporting program for cancer care as part of a learning health care system; and,Develop an ethically sound learning health care information technology system for cancer that enables real-time analysis of data from cancer patients in a variety of care settings. These recommendations underscore the need for independent national oversight, public-private collaboration, and substantial funding to create robust, patient-centered quality measurement and learning enterprises to improve the quality, accessibility, and affordability of cancer care in America.
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Affiliation(s)
- Tracy Spinks
- Clinical Operations, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1486, Houston, Texas 77030, 713-563-2198
| | - Patricia A. Ganz
- Division of Cancer Prevention & Control Research, UCLA Schools of Medicine and Public Health, Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095-6900, 310-206-1404
| | - George W. Sledge
- Division of Oncology, Stanford University Medical Center, 269 Campus Drive, CCSR 1115, MC:5151, Stanford, CA 94305, 650-724-4397
| | - Laura Levit
- Institute of Medicine, 500 5th St NW, Washington, DC 20001, 202-334-1343
| | - James A. Hayman
- Department of Radiation Oncology, University of Michigan, 1500 East Medical Center Drive, SPC 5010 - UH B2C490, Ann Arbor, MI 48109-5010, 734-647-9956
| | - Timothy J. Eberlein
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue - Box 8109, St. Louis, MO 63110, 314-362-8020, 314-454-1898
| | - Thomas W. Feeley
- Anesthesiology & Critical Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409, Houston, TX 77030, 713-792-7115
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Siegel EM, Jacobsen PB, Lee JH, Malafa M, Fulp W, Fletcher M, Smith JCR, Brown R, Levine R, Cartwright T, Abesada-Terk G, Kim G, Alemany C, Faig D, Sharp P, Markham MJ, Shibata D. Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval. J Am Coll Surg 2013; 218:16-25.e1-4. [PMID: 24275073 DOI: 10.1016/j.jamcollsurg.2013.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments. STUDY DESIGN Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined. RESULTS Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up. CONCLUSIONS The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level.
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Affiliation(s)
- Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL.
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ji-Hyun Lee
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
| | - William Fulp
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL
| | - Michelle Fletcher
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | | | - Richard Brown
- Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL
| | | | | | | | | | - Carlos Alemany
- Florida Institute of Research, Medicine, and Surgery, Orlando, FL
| | - Douglas Faig
- North Broward Medical Center, Deerfield Beach, FL
| | - Philip Sharp
- Tallahassee Memorial Healthcare, Tallahassee, FL
| | | | - David Shibata
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL
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Jagsi R, Chiang A, Polite BN, Medeiros BC, McNiff K, Abernethy AP, Zon R, Loehrer PJ. Qualitative analysis of practicing oncologists' attitudes and experiences regarding collection of patient-reported outcomes. J Oncol Pract 2013; 9:e290-7. [PMID: 23943890 DOI: 10.1200/jop.2012.000823] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is growing interest in incorporating routine collection of patient-reported outcomes (PROs) into cancer care. Practicing oncologists are a stakeholder group whose views are not well characterized. METHODS We developed an interview guide after literature review and in-depth interviews with leaders in the field. We conducted 45-minute semistructured interviews with a diverse sample of medical oncologists identified through affiliation with the Quality Oncology Practice Initiative or a minority-based Community Clinical Oncology Program until thematic saturation. Multiple analysts independently reviewed and thematically coded verbatim transcripts. RESULTS Seventeen interviews were conducted with oncologists from 15 states. Emergent themes included variable understanding and experience with PROs. There was enthusiasm for the potential of PROs to improve the efficiency and thoroughness of the patient encounter. Fundamental concerns included information overload, possibility of identifying problems without access to intervention, depersonalization of the physician-patient encounter, cost, and inefficiency. Barriers identified included the need for buy-in from other stakeholders in the practice, lack of appropriate referral resources, staffing needs, and technology concerns. Few identified patient compliance, data sharing/privacy, or medical liability as a major barrier to implementation. CONCLUSION Practicing oncologists had variable understanding of the details of PROs but, when introduced to the concept, recognized utility in improving the efficiency and thoroughness of the patient encounter if implemented properly. The time is right to begin pilot testing such measures with community oncologists so they can lend their expertise to national discussions on which measures to use and how best to use them.
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Affiliation(s)
- Reshma Jagsi
- University of Michigan, Ann Arbor, MI; Yale Cancer Center, New Haven, CT; University of Chicago, Chicago, IL; Stanford University, Stanford, CA; American Society of Clinical Oncology, Alexandria, VA; Duke University, Durham, NC; Michiana Hematology/Oncology, South Bend; and Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN
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Forsythe LP, Rowland JH, Padgett L, Blaseg K, Siegel SD, Dingman CM, Gillis TA. The cancer psychosocial care matrix: a community-derived evaluative tool for designing quality psychosocial cancer care delivery. Psychooncology 2013; 22:1953-62. [DOI: 10.1002/pon.3254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 01/06/2023]
Affiliation(s)
- Laura P. Forsythe
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
- Cancer Prevention Fellowship Program, Center for Cancer Training; National Cancer Institute, NIH/DHHS; Rockville MD USA
- Patient-Centered Outcomes Research Institute; Washington DC USA
| | - Julia H. Rowland
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
| | - Lynne Padgett
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences; National Cancer Institute, NIH/DHHS; Rockville MD USA
| | | | - Scott D. Siegel
- Helen F. Graham Cancer Center; Christiana Care Health System; Newark USA
| | - Chad M. Dingman
- Gibbs Cancer Center; Spartanburg Regional Healthcare System; Spartanburg USA
| | - Theresa A. Gillis
- Helen F. Graham Cancer Center; Christiana Care Health System; Newark USA
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Martinez KA, Aslakson RA, Wilson RF, Apostol CC, Fawole OA, Lau BD, Vollenweider D, Bass EB, Dy SM. A systematic review of health care interventions for pain in patients with advanced cancer. Am J Hosp Palliat Care 2013; 31:79-86. [PMID: 23408371 DOI: 10.1177/1049909113476129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Poorly controlled pain is common in advanced cancer. The objective of this article was to synthesize the evidence on the effectiveness of pain-focused interventions in this population. METHODS We searched MEDLINE, CINAHL, PsycINFO, Cochrane, and DARE from 2000 through December 2011. We included prospective, controlled health care intervention studies in advanced cancer populations, focusing on pain. RESULTS Nineteen studies met the inclusion criteria; most focused on nurse-led patient-centered interventions. In all, 9 (47%) of the 19 studies found a significant effect on pain. The most common intervention type was patient/caregiver education, in 17 (89%) of 19 studies, 7 of which demonstrated a significant decrease in pain. CONCLUSIONS We found moderate strength of evidence that pain in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
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Affiliation(s)
- Kathryn A Martinez
- 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hermes-Moll K, Klein G, Buschmann-Maiworm RE, Baumann W, Otremba B, Lebahn H, Steinmetz HT, Geraedts M, Kleeberg UR, Schmitz S. WINHO-Qualitätsindikatoren für die ambulante onkologische Versorgung in Deutschland. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:548-59. [DOI: 10.1016/j.zefq.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 08/06/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022]
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Partridge AH, Norris VW, Blinder VS, Cutter BA, Halpern MT, Malin J, Neuss MN, Wolff AC. Implementing a breast cancer registry and treatment plan/summary program in clinical practice: a pilot program. Cancer 2012. [PMID: 23197186 DOI: 10.1002/cncr.27625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a need to better measure and improve the quality of oncology care and improve communication with patients and other providers. The American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot evaluated the feasibility and acceptability of prospective data collection for quality assessment in daily clinical practice. Data were used to create and share treatment plans/summaries (TPSs) at the point of care. METHODS Using a web-based tool, 20 diverse practices entered clinical data on each new early-stage breast cancer patient into the BCR for 14 months (September 2009 through November 2010). The tool created individual TPSs that were shared with patients. Practices received practice-specific and aggregate BCR quality measures data, participated in a survey, and received a participation stipend. RESULTS Twenty practices entered 2014 patients into the BCR, collecting demographic, clinical, and treatment information. Fifty-two percent of practice participants replied to an end-of-pilot survey: 73% were satisfied with the BCR and web-based tool, 31% expressed concern regarding time and effort, and 52% reported additional practice costs during the pilot. Among those who created or shared the TPSs, 90% thought the documents improved oncologist-patient communication, and 95% favored using BCR data for practice quality improvement. CONCLUSIONS Prospective data collection for quality assessment is feasible and allows sharing of TPSs with patients at the point of care. Future efforts should focus on decreasing implementation burden to practices, broadening participation, examining costs, and, most importantly, assessing its effects on patient outcomes.
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Jacobson JO. Counterpoint: sowing the seeds of standardized care to reap better patient outcomes. J Oncol Pract 2012. [PMID: 23180989 DOI: 10.1200/jop.2012.000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Blayney DW, Severson J, Martin CJ, Kadlubek P, Ruane T, Harrison K. Michigan oncology practices showed varying adherence rates to practice guidelines, but quality interventions improved care. Health Aff (Millwood) 2012; 31:718-28. [PMID: 22492888 DOI: 10.1377/hlthaff.2011.1295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.
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Pattern of prophylaxis administration for chemotherapy-induced nausea and vomiting: an analysis of city-based health insurance data. Int J Clin Oncol 2012; 18:971-6. [PMID: 23011102 DOI: 10.1007/s10147-012-0477-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
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