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Boyle JM, van der Meulen J, Kuryba A, Cowling TE, Booth C, Fearnhead NS, Braun MS, Walker K, Aggarwal A. Measuring variation in the quality of systemic anti-cancer therapy delivery across hospitals: A national population-based evaluation. Eur J Cancer 2023; 178:191-204. [PMID: 36459767 DOI: 10.1016/j.ejca.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
AIM To date, there has been little systematic assessment of the quality of care associated with systemic anti-cancer therapy (SACT) delivery across national healthcare systems. We evaluated hospital-level toxicity rates during SACT treatment as a means of identifying variation in care quality. METHODS All colorectal cancer (CRC) patients receiving SACT within 106 English National Health Service (NHS) hospitals between 2016 and 2019 were included. Severe acute toxicity rates were derived from hospital administrative data using a validated coding framework. Variation in hospital-level toxicity rates was assessed separately in the adjuvant and metastatic settings. Toxicity rates were adjusted for age, sex, comorbidity, performance status, tumour site, and TNM staging. RESULTS Eight thousand one hundred and seventy three patients received SACT in the adjuvant setting, and 7,683 patients in the metastatic setting. Adjusted severe acute toxicity rates varied between hospitals from 11% to 49% for the adjuvant cohort, and from 25% to 67% for the metastatic cohort. Compared to the national mean toxicity rate in the adjuvant cohort, six hospitals were more than two standard deviations (2SD) above, and four hospitals were more than 2SD below. In the metastatic cohort, six hospitals were more than 2SD above, and seven hospitals were more than 2SD below the national mean toxicity rate. Overall, 12 hospitals (12%) had toxicity rates more than 2SD above the national mean, and 11 (10%) had rates more than 2SD below. CONCLUSION There is substantial variation in hospital-level severe acute toxicity rates in both the adjuvant and metastatic settings, despite risk-adjustment. Ongoing reporting of this performance indicator can be used to focus further investigation of toxicity rates and stimulate quality improvement initiatives to improve care.
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Affiliation(s)
- Jemma M Boyle
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Angela Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | | | - Nicola S Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Michael S Braun
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK; School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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2
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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3
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Aggarwal A, Nossiter J, Parry M, Sujenthiran A, Zietman A, Clarke N, Payne H, van der Meulen J. Public reporting of outcomes in radiation oncology: the National Prostate Cancer Audit. Lancet Oncol 2021; 22:e207-e215. [DOI: 10.1016/s1470-2045(20)30558-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
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Prang KH, Canaway R, Bismark M, Dunt D, Miller JA, Kelaher M. The impact of public performance reporting on cancer elective surgery waiting times: a data linkage study. BMC Health Serv Res 2021; 21:129. [PMID: 33557805 PMCID: PMC7871621 DOI: 10.1186/s12913-021-06132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background Excessive waiting times for cancer elective surgery are a concern in publicly funded healthcare systems. Several countries including Australia have introduced healthcare reforms involving time-based targets and public performance reporting (PPR) of hospital data. However, there is mixed evidence of their benefits. We sought to examine the impact of targets and PPR of cancer elective surgery waiting times on access to breast, bowel and lung cancer elective surgery. Methods We analysed routinely-collected linked data on admissions and waiting times for patients aged 15 years or over (n = 199,885) who underwent cancer surgery in a public hospital in Victoria, Australia over a 10-year period. We conducted difference-in-differences analyses to compare waiting times before (2006–07 to 2011–12) and after (2012–13 to 2015–16) the introduction of PPR in meeting these targets. Results Across all cancer types, urgent patients were all treated within 30 days before and after PPR. Following PPR, there was a slight increase in the mean waiting times across all cancer types and urgency categories. Patients with lung cancer waited on average two and half days longer for treatment and patients with breast cancer waited on average half-a-day less. There was no effect of PPR on waiting times for patients with bowel cancer across urgency categories. Conclusions Our findings suggest that time-based targets and PPR had minimal impact on surgical waiting times. This may be due to reasonable waiting times prior to PPR, improved efficiency being masked by 20% growth in the population, lack of public knowledge that waiting times are publicly reported, or lack of real-time reporting to drive behavioural change. The use of generic elective surgery recommended waiting time measures for cancer is discussed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06132-w.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mitchell KAR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:351-361. [PMID: 32197731 PMCID: PMC7086403 DOI: 10.1016/j.jval.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/26/2019] [Accepted: 10/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To increase the understanding of patient-centered care (PCC) and address the need for cross-cutting quality cancer care measures that are relevant to both patients and providers. METHODS An exploratory factor analysis (EFA) was performed on a short version of the Patients and the Cancer Care Experience Survey, a patient-reported measure of perceived importance of social, emotional, physical, and informational aspects of care, administered to adult patients (n = 104) at a National Cancer Institute-designated comprehensive cancer center. Relationships between PCC dimensions and patient characteristics were also assessed. Principal axis factoring was applied and bivariate analyses were performed using Wilcoxon rank-sum tests. RESULTS Most of our sample was over 60 years old (63.4%), female (57.4%), and white (74.2%), with either breast (41.2%) or prostate cancer (27.5%). A 5-factor model was identified: (1) quality of life (α = .91), (2) provider social support (α = .83), (3) psychosocial needs (α = .91), (4) nonprovider social support (α = .79), and (5) health information and decision-making support (α = .88). No statistically significant associations were found between these factors and patients' characteristics. CONCLUSIONS A preliminary factor structure for a cancer PCC measure was identified. Our findings reinforce the interrelated nature of PCC dimensions. The lessons learned from this study may be used to develop a single PCC measure that identifies patient priorities across the cancer care continuum. Data collected from such a measure can be used to support patient engagement in treatment planning and decision-making.
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Affiliation(s)
- Kerri-Anne R Mitchell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Aubree Shay
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
| | - Andrew E Springer
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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6
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Lavery JA, Lipitz-Snyderman A, Li DG, Bach PB, Panageas KS. Assessing whether cancer stage is needed to evaluate measures of hospital surgical performance. J Eval Clin Pract 2020; 26:66-71. [PMID: 31069903 PMCID: PMC6842027 DOI: 10.1111/jep.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Abstract
RATIONAL, AIMS, AND OBJECTIVES While public reports of hospital-level surgical quality measures are becoming increasingly common in health care, a comprehensive national assessment of surgical quality across multiple cancer sites has yet to be developed. Fee-for-service (FFS) Medicare claims present a potential resource from which to measure outcomes following cancer surgery given the national scope of patients and providers. However, due to the administrative nature of the data, clinical cancer information such as stage is not recorded. Leveraging the Surveillance, Epidemiology, and End Results (SEER) registry linked to FFS Medicare claims to analyse outcomes for patients whom we ultimately know stage information, we determined whether Medicare claims are suitable for measuring provider quality following cancer surgery by assessing the extent to which the lack of stage information modifies assessments of provider performance. METHODS We identified patients aged 66 and older undergoing cancer surgery between 2011 and 2013 from SEER-Medicare. We compared the changes in the risk-standardized rates (RSRs), decile rankings, and c-statistics with and without risk adjustment for cancer stage for three measures of hospital performance: 30-day mortality, surgical complications, and unplanned readmissions. RESULTS The RSR changed by at most 11.4% for mortality and by less than 4% for complications and readmissions, indicating that measures of hospital performance were stable with and without adjustment for stage. The relative performance of hospitals was also stable, as demonstrated by fewer than 20% of hospitals changing decile rank. The c-statistic declined by less than 2% across all measures, indicating that model fit was not substantially worsened without this information. CONCLUSION These findings support the use of FFS Medicare claims for hospital-level analyses of short-term outcomes following cancer surgery. Quality reporting based on these analyses can be used to help patients choose among hospitals and for evaluating policies to improve surgical cancer care.
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Affiliation(s)
- Jessica A Lavery
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Lipitz-Snyderman
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Diane G Li
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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7
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Voluntary Hospital Reporting of Performance in Cancer Care: Does Volume Make a Difference? J Healthc Qual 2019; 42:e75-e82. [PMID: 31599760 DOI: 10.1097/jhq.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about which hospitals participate in voluntary public reporting of quality processes and what influences their performance, particularly in cancer care. We hypothesize that patient volume is positively associated with both reporting and performance. In 2014, when Pennsylvania became the first and only state to have public reporting for cancer care, it became possible to test these hypotheses, which we did in cross-sectional study of the 72 Pennsylvania hospitals accredited by the Commission on Cancer. Hospitals that publicly reported their performance (57 of 72) had higher patient volumes than hospitals that did not release performance. Among reporting hospitals, no association was found between patient volume and performance on process of care metrics. These findings suggest the importance of attending to volume effects in public reporting of cancer care and recognizing that volume is not a predictor of performance for reporting hospitals, which indicates the need for research to identify other factors that differentiate performance within and across reporting and nonreporting hospitals.
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8
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Merkow RP, Yang AD, Pavey E, Song MW, Chung JW, Bentrem DJ, Bilimoria KY. Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care. JAMA Intern Med 2019; 179:1043-1051. [PMID: 31206142 PMCID: PMC6580440 DOI: 10.1001/jamainternmed.2019.0914] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Congress has exempted 11 specialized cancer centers in the United States from the Prospective Payment System (PPS). These centers are also exempt from reporting many of the process-of-care and outcome measures to the Centers for Medicare & Medicaid Services that are required for hospitals in the PPS. It is not known how hospitals affiliated with PPS-exempt cancer centers differ from other hospitals affiliated with National Cancer Institute cancer centers (NCI-CCs) or other US hospitals that provide cancer care. OBJECTIVE To examine differences between hospitals affiliated with PPS-exempt cancer centers, other hospitals affiliated with NCI-CCs, and other hospitals that provide cancer care on metrics that could be used in public reporting. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study compared hospital characteristics and cancer-related services using data from the American Hospital Association Annual Survey and US News Best Hospitals rankings. With a 100% sample of Medicare beneficiaries who underwent 1 of 9 cancer operations (brain tumor resection, colorectal resection, cystectomy, esophagectomy, gastrectomy, liver resection, lung resection, pancreatic resection, prostatectomy) from January 1, 2011, to May 31, 2015, we used hierarchical logistic regression methods to compare differences in 18 postoperative outcomes. Data analysis was conducted from February 2018 to August 2018. MAIN OUTCOMES AND MEASURES This study evaluated hospital characteristics, including cancer-specific services, patient comorbidity burden, and cancer surgery postoperative outcomes, from PPS-exempt cancer centers, NCI-affiliated cancer centers, and other US hospitals that provide cancer care. RESULTS Hospitals affiliated with PPS-exempt cancer centers (n = 15) and NCI-CCs (n = 54) were similar in hospital characteristics, basic cancer-related services, and patient comorbidity burden. Compared with NCI-CCs, PPS-exempt cancer centers had significantly higher US News reputation scores (mean [SD], 17.5 [24.0] vs 2.6 [4.8]; P < .001) but no differences in oncology patient volume, patient safety ratings, comorbidity burden, nurse staffing, US News total cancer scores, or US News survival scores. Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had similar adjusted postoperative outcomes for 15 of 18 measures, including mortality, readmission, and surgical site infections. Compared with hospitals affiliated with PPS-exempt cancer centers, patients treated at NCI-CCs were more likely to have postoperative sepsis (3.1% vs 1.7%; P = .002), acute renal failure (6.2% vs 3.9%; P = .01), and urinary tract infection (6.4% vs 4.0%; P = .002). Compared with the other hospitals that provide cancer care (n = 3578), PPS-exempt cancer center status was associated with improved outcomes for 7 of 18 measures, including mortality, sepsis, acute renal failure, pulmonary failure, and failure to rescue. CONCLUSIONS AND RELEVANCE Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had generally similar hospital characteristics, patient comorbidity burden, and cancer surgery outcomes. These findings raise questions about why some cancer centers are designated as PPS-exempt and why most hospitals are not required to publicly report cancer-specific quality metrics.
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Affiliation(s)
- Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Pavey
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Min-Woong Song
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Jeanette W Chung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David J Bentrem
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Jesse Brown VA Medical Center, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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9
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Chimonas S, Fortier E, Li DG, Lipitz-Snyderman A. Facts and Fears in Public Reporting: Patients' Information Needs and Priorities When Selecting a Hospital for Cancer Care. Med Decis Making 2019; 39:632-641. [PMID: 31226909 DOI: 10.1177/0272989x19855050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Public reporting on the quality of provider care has the potential to empower patients to make evidence-based decisions. Yet patients seldom consult resources such as provider report cards in part because they perceive the information as irrelevant. To inform more effective public reporting, we investigated patients' information priorities when selecting a hospital for cancer treatment. We hypothesized that patients would be most interested in data on clinical outcomes. Methods. An experienced moderator led a series of focus groups using a semistructured discussion guide. Separate sessions were held with patients aged 18 to 54 years and those older than 54 years in Philadelphia, Pennsylvania; Phoenix, Arizona; and Indianapolis, Indiana, in 2017. All 38 participants had received treatment for cancer within the past 2 years and had a choice of hospitals. Results. In selecting hospitals for cancer treatment, many participants reported that they considered factors such as reputation, quality of the facilities, and experiences of other patients. For most, however, decisions were guided by trusted advisors, with the majority agreeing that a physician's opinion would sway them to disregard objective data about hospital quality. Nonetheless, nearly all expressed interest in having comparative data. Participants varied in selecting from a hypothetical list, "the top 3 things you would want to know when choosing a hospital for cancer care." The most commonly preferred items were overall care quality, timeliness, and patient satisfaction. Contrary to our hypothesis, many preferred to avoid viewing comparative clinical outcomes, particularly survival. Conclusions. Patients' information preferences are diverse. Fear or other emotional responses might deter patients from viewing outcomes data such as survival. Additional research should explore optimal ways to help patients incorporate comparative data on the components of quality they value into decision making.
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Affiliation(s)
- Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth Fortier
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diane G Li
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allison Lipitz-Snyderman
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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Steven B, Lange L, Schulz H, Bleich C. Views of psycho-oncologists, physicians, and nurses on cancer care-A qualitative study. PLoS One 2019; 14:e0210325. [PMID: 30650112 PMCID: PMC6334960 DOI: 10.1371/journal.pone.0210325] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care. MATERIALS AND METHODS Semi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes. RESULTS The following five principle themes were identified in the interviews: "psycho-oncological care", "cooperation of health care providers", "palliative care", "health care provider-patient contact", and "coordination and organization of care". Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers. CONCLUSIONS The statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.
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Affiliation(s)
- Berenike Steven
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Lange
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Factors Associated With Hospices' Nonparticipation in Medicare's Hospice Compare Public Reporting Program. Med Care 2018; 57:28-35. [PMID: 30489545 DOI: 10.1097/mlr.0000000000001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To enhance the quality of hospice care and to facilitate consumers' choices, the Centers for Medicare and Medicaid Services (CMS) began the Hospice Quality Reporting Program, in which CMS posted the quality measures of participating hospices on its reporting website, Hospice Compare. Little is known about the participation rate and the types of nonparticipating hospices. OBJECTIVE To examine the factors associated with hospices' nonparticipation in Hospice Compare. RESEARCH DESIGN We analyzed data from the CMS 2016 Hospice Compare. "Nonparticipants" were those who did not submit any quality measure. With the data of the Provider of Service file, the Healthcare Cost Report Information System, and the Area Health Resources File, multivariate logistic regressions estimated the association between nonparticipants and hospice and market characteristics, including ownership, size, nurse staffing ratio, and market competition intensity. RESULTS Among the 4123 certified hospices subject to penalty from nonparticipation, 259 did not participate in Hospice Compare. California, New Mexico, Texas, and Wyoming had participation rates lower than 80%. Hospices that were for-profit, had no accreditation, had few nurses per patient day, provided no inpatient care, and were located in competitive markets were less likely to participate than other hospices. CONCLUSIONS Hospice Compare successfully motivated hospice in participating in the quality report program in most of states. For-profit hospices, hospices with less quality, and hospices located in competitive markets were less likely to participate. Further research is warranted to examine the quality of these nonparticipants, especially in the 4 states with a lower participation rate.
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Yang A, Chimonas S, Bach PB, Taylor DJ, Lipitz-Snyderman A. Critical Choices: What Information Do Patients Want When Selecting a Hospital for Cancer Surgery? J Oncol Pract 2018; 14:e505-e512. [PMID: 30059273 PMCID: PMC6550060 DOI: 10.1200/jop.17.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Access to comparative information on hospitals' quality of cancer care is limited. Patients' interest in using this information when selecting a hospital for cancer surgery and the specific data they would desire are unknown. This study gauges patients' demand for comparative information on hospitals' quality of cancer surgery. METHODS We conducted a cross-sectional, national survey of 3,334 US residents who had received cancer surgery. The outcomes were patients' reported likelihood of using a list of best hospitals for cancer surgery and patients' reported interest in information about specific clinical outcomes, including 4-year survival after surgery, 30-day mortality after surgery, and rate of complications from surgery. RESULTS Two thirds of patients (68%) reported being actively involved in selecting a hospital for their surgery, and two thirds (65%) reported that their physician was involved in or made this decision. When asked what information might have helped them to choose a hospital, participants identified the hospital's reputation (55%), patient satisfaction (44%), and the number of cancer surgeries performed at the hospital (36%). Approximately three quarters (73%) reported being likely to use a list of best hospitals for cancer surgery when selecting a hospital. Approximately 40% expressed interest in having information on at least one clinical outcome. CONCLUSION Widespread interest exists among patients with cancer for comparative information on hospital quality as well as on clinical outcomes and hospitals' reputation for cancer surgery. Policy reforms and additional research should address the unmet need for transparent, comprehensive data on the quality of hospitals' cancer care.
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Affiliation(s)
- Annie Yang
- Memorial Sloan Kettering Cancer Center, New York, NY; and Inspire, Arlington, VA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, New York, NY; and Inspire, Arlington, VA
| | - Peter B. Bach
- Memorial Sloan Kettering Cancer Center, New York, NY; and Inspire, Arlington, VA
| | - David J. Taylor
- Memorial Sloan Kettering Cancer Center, New York, NY; and Inspire, Arlington, VA
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13
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Lipitz-Snyderman A, Pfister D, Classen D, Atoria CL, Killen A, Epstein AS, Anderson C, Fortier E, Weingart SN. Preventable and mitigable adverse events in cancer care: Measuring risk and harm across the continuum. Cancer 2017; 123:4728-4736. [PMID: 28817180 DOI: 10.1002/cncr.30916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 06/28/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patient safety is a critical concern in clinical oncology, but the ability to measure adverse events (AEs) across cancer care is limited by a narrow focus on treatment-related toxicities. The objective of this study was to assess the nature and extent of AEs among cancer patients across inpatient and outpatient settings. METHODS This was a retrospective cohort study of 400 adult patients selected by stratified random sampling who had breast (n = 128), colorectal (n = 136), or lung cancer (n = 136) treated at a comprehensive cancer center in 2012. Candidate AEs, or injuries due to medical care, were identified by trained nurse reviewers over the course of 1 year from medical records and safety-reporting databases. Physicians determined the AE harm severity and the likelihood of preventability and harm mitigation. RESULTS The 400-patient sample represented 133,358 days of follow-up. Three hundred four AEs were identified for an overall rate of 2.3 events per 1000 patient days (91.2 per 1000 inpatient days and 0.9 per 1000 outpatient days). Thirty-four percent of the patients had 1 or more AEs (95% confidence interval, 29%-39%), and 16% of the patients had 1 or more preventable or mitigable AEs (95% confidence interval, 13%-20%). The AE rate for patients with breast cancer was lower than the rate for patients with colorectal or lung cancer (P ≤ .001). The preventable or mitigable AE rate was 0.9 per 1000 patient days. Six percent of AEs and 4% of preventable AEs resulted in serious harm. Examples included lymphedema, abscess, and renal failure. CONCLUSIONS A heavy burden of AEs, including preventable or mitigable events, has been identified. Future research should examine risk factors and improvement strategies for reducing their burden. Cancer 2017;123:4728-4736. © 2017 American Cancer Society.
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Affiliation(s)
| | - David Pfister
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Classen
- Pascal Metrics, Washington, DC.,University of Utah School of Medicine, Salt Lake City, Utah
| | - Coral L Atoria
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aileen Killen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Saul N Weingart
- Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
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McMullen S, Szabo S, Halbert R, Lai C, Parikh A, Bunce M, Khoury R, Small A, Masaquel A. Tools for Communication: Novel Infrastructure to Address Patient-Perceived Gaps in Oncology Care. Clin J Oncol Nurs 2017; 21:E38-E48. [DOI: 10.1188/17.cjon.e38-e48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Burke HB. Improving the safety and quality of cancer care. Cancer 2017; 123:549-550. [PMID: 27911978 DOI: 10.1002/cncr.30438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
The cancer community is increasingly interested in improving its safety and quality. Improvement will be driven by the expansion of safety and quality research and by a commitment to publish studies that advance high-quality, safe cancer care. Cancer 2017;123:549-550. © 2016 American Cancer Society.
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Affiliation(s)
- Harry B Burke
- Section of Patient Safety and Quality, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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16
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Lipitz-Snyderman A, Weingart SN, Anderson C, Epstein AS, Killen A, Classen D, Sima CS, Fortier E, Atoria CL, Pfister D, Lipitz-Snyderman A, Weingart SN, Anderson C, Epstein AS, Killen A, Classen D, Sima CS, Fortier E, Atoria CL, Pfister D. ReCAP: Detection of Potentially Avoidable Harm in Oncology From Patient Medical Records. J Oncol Pract 2016; 12:178-9; e224-30. [PMID: 26869656 DOI: 10.1200/jop.2015.006874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Widespread consensus exists about the importance of addressing patient safety issues in oncology, yet our understanding of the frequency, spectrum, and preventability of adverse events (AEs) across cancer care is limited. METHODS We developed a screening tool to detect AEs across cancer care settings through medical record review. Members of the study team reviewed the scientific literature and obtained structured input from an external multidisciplinary panel of clinicians by using a modified Delphi process. RESULTS The screening tool comprises 76 triggers-readily identifiable findings to screen for possible AEs that occur during cancer care. Categories of triggers are general care, vital signs, medication related, laboratory tests, other orders, and consultations. CONCLUSION Although additional testing is required to assess its performance characteristics, this tool may offer an efficient mechanism for identifying possibly preventable AEs in oncology and serve as an instrument for quality improvement.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Saul N Weingart
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Christopher Anderson
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Andrew S Epstein
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Aileen Killen
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - David Classen
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Camelia S Sima
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Elizabeth Fortier
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Coral L Atoria
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - David Pfister
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Allison Lipitz-Snyderman
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA.
| | - Saul N Weingart
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Christopher Anderson
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Andrew S Epstein
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Aileen Killen
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - David Classen
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Camelia S Sima
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Elizabeth Fortier
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - Coral L Atoria
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
| | - David Pfister
- Memorial Sloan Kettering Cancer Center; Columbia University Medical Center; AIG, New York, NY; Tufts Medical Center, Boston, MA; Pascal Metrics, Washington, DC; University of Utah School of Medicine, Salt Lake City, UT; and Genentech, San Francisco, CA
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Hiatt RA, Tai CG, Blayney DW, Deapen D, Hogarth M, Kizer KW, Lipscomb J, Malin J, Phillips SK, Santa J, Schrag D. Leveraging State Cancer Registries to Measure and Improve the Quality of Cancer Care: A Potential Strategy for California and Beyond. J Natl Cancer Inst 2015; 107:djv047. [DOI: 10.1093/jnci/djv047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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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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19
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Mohanty S, Kinnier CV, Bilimoria KY. Patient satisfaction, outcomes, and the need for cancer-specific quality metrics. J Natl Cancer Inst 2015; 107:dju438. [PMID: 25618902 DOI: 10.1093/jnci/dju438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sanjay Mohanty
- Surgical Outcomes and Quality Improvement Center, Department of Surgery (SM, CVK, KYB) and Northwestern Institute for Comparative Effectiveness Research in Oncology (SM, CVK, KYB), Chicago, IL; Department of Surgery, Henry Ford Hospital (SM), Detroit, MI; Department of Surgery, Massachusetts General Hospital (CVK), Boston, MA
| | - Christine V Kinnier
- Surgical Outcomes and Quality Improvement Center, Department of Surgery (SM, CVK, KYB) and Northwestern Institute for Comparative Effectiveness Research in Oncology (SM, CVK, KYB), Chicago, IL; Department of Surgery, Henry Ford Hospital (SM), Detroit, MI; Department of Surgery, Massachusetts General Hospital (CVK), Boston, MA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery (SM, CVK, KYB) and Northwestern Institute for Comparative Effectiveness Research in Oncology (SM, CVK, KYB), Chicago, IL; Department of Surgery, Henry Ford Hospital (SM), Detroit, MI; Department of Surgery, Massachusetts General Hospital (CVK), Boston, MA.
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Adelson KB, Qiu YC, Evangelista M, Spencer-Cisek P, Whipple C, Holcombe RF. Implementation of Electronic Chemotherapy Ordering: An Opportunity to Improve Evidence-Based Oncology Care. J Oncol Pract 2014; 10:e113-9. [DOI: 10.1200/jop.2013.001184] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors anticipate that the Epic Beacon platform will allow them to capture data on chemotherapy regimen use for each disease by stage, individual regimen toxicity, and patients' clinical outcome.
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Affiliation(s)
- Kerin B. Adelson
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Ying Chun Qiu
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Michelle Evangelista
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Patricia Spencer-Cisek
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Clare Whipple
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
| | - Randall F. Holcombe
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; Epic Transformation Group, Mount Sinai Hospital, New York, NY
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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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The use of decision support to measure documented adherence to a national imaging quality measure. Acad Radiol 2014; 21:378-83. [PMID: 24507424 DOI: 10.1016/j.acra.2013.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/24/2013] [Accepted: 10/28/2013] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES Present methods for measuring adherence to national imaging quality measures often require a resource-intensive chart review. Computerized decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure (NQM) regarding computed tomography pulmonary angiograms (CTPAs) for pulmonary embolism using measure-targeted clinical decision support and whether the associated increased burden of data captured required by this system would affect the use and yield of CTs. MATERIALS AND METHODS This institutional review board-approved prospective cohort study enrolled patients from September 1, 2009, through November 30, 2011, in the emergency department (ED) of a 776-bed quaternary-care adults-only academic medical center. Our intervention consisted of an NQM-targeted clinical decision support tool for CTPAs, which required mandatory input of the Wells criteria and serum D-dimer level. The primary outcome was the documented adherence to the quality measure prior and subsequent to the intervention, and the secondary outcomes were the use and yield of CTPAs. RESULTS A total of 1209 patients with suspected PE (2.0% of 58,795 ED visits) were imaged by CTPA during the 12-month control period, and 1212 patients were imaged in the 12 months after the quarter during which the intervention was implemented (2.0% of 59,478 ED visits, P = .84). Documented baseline adherence to the NQM was 56.9% based on a structured review of the provider notes. After implementation, documented adherence increased to 75.6% (P < .01). CTPA yield remained unchanged and was 10.4% during the control period and 10.1% after the intervention (P = .88). CONCLUSIONS Implementation of a clinical decision support tool significantly improved documented adherence to an NQM, enabling automated measurement of provider adherence to evidence without the need for resource-intensive chart review. It did not adversely affect the use or yield of CTPAs.
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Merkow RP, Bilimoria KY, Bentrem DJ, Pitt HA, Winchester DP, Posner MC, Ko CY, Pawlik TM. National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery. Ann Surg Oncol 2013; 21:1067-74. [DOI: 10.1245/s10434-013-3338-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Indexed: 12/13/2022]
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Effect of Cancer Surgery Complexity on Short-Term Outcomes, Risk Predictions, and Hospital Comparisons. J Am Coll Surg 2013; 217:685-93. [DOI: 10.1016/j.jamcollsurg.2013.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 11/21/2022]
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Wild C, Patera N. Measuring quality in cancer care: overview of initiatives in selected countries. Eur J Cancer Care (Engl) 2013; 22:773-81. [DOI: 10.1111/ecc.12089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C. Wild
- Ludwig Boltzmann Institute for Health Technology Assessment; Vienna Austria
| | - N. Patera
- Ludwig Boltzmann Institute for Health Technology Assessment; Vienna Austria
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Cohn DE, Leitao M, Levenback C, Berkowitz R, Roman L, Lucci J, Kim S, Lancaster J, Odunsi K, Wakabayashi M, Goff BA. Reporting of quality measures in gynecologic oncology programs at Prospective Payment System (PPS)-Exempt Cancer Hospitals: an early glimpse into a challenging initiative. Gynecol Oncol 2013; 130:403-6. [PMID: 23718934 DOI: 10.1016/j.ygyno.2013.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The Affordable Care Act mandates the Prospective Payment System (PPS)-Exempt Cancer Hospitals Quality Reporting program. These 11 hospitals (which are paid fee-for-service rather than on a DRG system) began reporting measures (2 general safety, 2 breast, 1 colon) in 2013. Given this reporting mandate, we set out to determine whether the PPS-exempt gynecologic oncology programs could identify quality measures specific to the care of our patients. METHODS A list of 12 quality measures specific to gynecologic oncology was created (from sources including the National Quality Forum and the SGO). Measures already in use were not included. The list was ranked by the gynecologic oncology program directors at the PPS-exempt hospitals. Descriptive statistics (including mean and SD for rankings) were utilized. RESULTS Despite mandatory reporting of quality measures for PPS-exempt cancer hospitals, little consensus exists regarding specific gynecologic cancer measures. Documentation of debulking status, cancer survival, and offering minimally invasive surgery (for endometrial cancer) and intraperitoneal chemotherapy (for ovarian cancer) are important, but with widely variable responses (when ranked 1-12, standard deviations are 2-3). General issues regarding adherence to guidelines for the use of GCSF, documentation of functional status, and tracking of patient satisfaction scores were ranked the lowest. Three of the directors reported that their compensation is partially linked to quality outcomes. CONCLUSIONS There is wide variability in ranking of quality measures, and may relate to provider or institutional factors. Despite the mandatory reporting in PPS-exempt cancer hospitals, work remains to define gynecologic cancer quality measures.
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Neuss MN, Malin JL, Chan S, Kadlubek PJ, Adams JL, Jacobson JO, Blayney DW, Simone JV. Measuring the improving quality of outpatient care in medical oncology practices in the United States. J Clin Oncol 2013; 31:1471-7. [PMID: 23478057 DOI: 10.1200/jco.2012.43.3300] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement. METHODS The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement. RESULTS Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time. CONCLUSION Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.
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Affiliation(s)
- Michael N Neuss
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Ave, #694 Preston Research Building, Nashville, TN 37232, USA.
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Merkow RP, Bentrem DJ, Winchester DP, Stewart AK, Ko CY, Bilimoria KY. Effect of Including Cancer-Specific Variables on Risk-Adjusted Hospital Surgical Quality Comparisons. Ann Surg Oncol 2013; 20:1766-73. [DOI: 10.1245/s10434-013-2867-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Indexed: 11/18/2022]
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Merkow RP, Kmiecik TE, Bentrem DJ, Winchester DP, Stewart AK, Ko CY, Bilimoria KY. Effect of including cancer-specific variables on models examining short-term outcomes. Cancer 2012. [DOI: 10.1002/cncr.27891] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Luke J, Mirkin J, Bach P. Improving quality and addressing the rising costs of cancer care: two birds, one stone. J Oncol Pract 2012; 7:402-4. [PMID: 22379427 DOI: 10.1200/jop.2011.000419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 11/20/2022] Open
Abstract
The authors discuss the current state of Medicare reimbursement policy and outline their recently published model to link improvements in the quality of cancer care to reductions in overall cost.
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Affiliation(s)
- Jason Luke
- Memorial Sloan-Kettering Cancer Center, New York, NY
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