The Ipaac Evaluation Tool: how to select Quality Indicators for Comprehensive Cancer Care Networks

Abstract Background The Comprehensive Cancer Care Networks (CCCNs) represent innovative approaches for the management of cancer patients consisting of multiple cooperating health units with specific expertise in the different steps of care. Quality Indicators (QIs) constitute valid and reliable tools that allow to measure the quality of care among similar structures belonging to different health systems. Objective of this project was to develop a standardized tool in order to define a multi-step process for the selection of QIs for the evaluation of CCCNs. Methods Under the coordination of the Innovative Partnership for Action Against Cancer (IPAAC) joint action, our research team performed a systematic review of the scientific literature to identify the reported methodology for the selection of QIs applicable for the CCCNs' setting. An additional search of national and international Quality Assurance organizations was performed to detect any missing information. Results The IET (Ipaac Evaluation Tool) for QIs was developed: a methodological tool describing an 8-step process that leads to the selection of QIs feasible for the CCCN setting. The tool was implemented accordingly with the reporting standards for guideline-based performance measures of the Guideline International Network (GIN). A pilot testing of the tool was performed in order to identify its strengths and weaknesses. Conclusions The IET for QIs represents an innovative methodological instrument to select valid and reliable indicators for the assessment of the quality of care within the CCCN settings. Key messages The Quality Indicators represent valid and reliable tools to measure and compare the quality of care delivered to cancer patients in Comprehensive Cancer Care Networks. The development of the Ipaac Evaluation Tool leads to a standardized assessment of the quality of care provided for cancer patients within the CCCN setting.

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Breast cancer patients' quality of care: Does racial concordance matter or is it just a matter of trust?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6537 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6537-6537

Author(s):

K. P. Joseph ◽

R. Franco ◽

K. Fei ◽

N. Bickell

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Cancer Patients ◽

Cancer Care ◽

Perceived Quality ◽

Care Quality ◽

Breast Cancer Patients ◽

Office Staff ◽

Racial Concordance

6537 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients' perceived quality of cancer care matter. Concordance by race in physician-patient relationships has been associated with patient satisfaction and use of health care, however how that is mediated is unclear. Methods: 210 of 300 eligible women stage I or II breast cancer at 1 of 8 participating NYC hospitals responded to our survey (70% response rate): 20% were African-American (AA), 40% were white, and 30% were Hispanic and 9% were other races. Trust is based on a validated scale and calibrated to a 100 point scale (Cronbach α = 0.76). Bivariate analyses and logistic models were used to identify factors associated with patient ratings of quality of care. Results: Only 55% of women rated the quality of their cancer care as excellent. AA women breast cancer patients were less likely to rate their care as excellent (p=0.004). Compared to women who didn't rate their care as excellent, those who rated it excellent had greater trust in their physician (p < 0.0001) and indicated that were treated well by their physicians' office staff (p = 0.01). Of note, AA patients had lower levels of trust (p = 0.004). Women who were of the same race as their physician did not perceive better quality of care as compared to those who were not racially concordant (p = 0.18); nor did they have higher trust in their physician (p = 0.59). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to, how well the staff treated the patient, and racial concordance with physician, found that trust in physician was significantly associated with patient perception of excellent quality care (aRR = 1.38; 95%CI: 1.03–1.65) and being AA was associated with worse perceived quality (aRR = 0.47; 95%CI: 0.21–0.88) (model c = 0.79; p < 0.0001). Conclusions: Racial concordance between physicians and patients does not directly affect patients' perceived quality of care. However, women's trust in their physician and their perceived treatment by office staff are associated with excellent cancer care quality ratings. Efforts should be made to increase effective intercultural communication particularly among AA women in order to improve ratings of cancer care quality. No significant financial relationships to disclose.

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Reporting Program for Cancer Care Quality Indicators

Journal of Oncology Practice ◽

10.1200/jop.2014.001339 ◽

2015 ◽

Vol 11 (2) ◽

pp. 158-160 ◽

Cited By ~ 12

Author(s):

Christoph Kowalski ◽

Hilde Schulte ◽

Simone Wesselmann

Keyword(s):

Quality Of Care ◽

Quality Indicators ◽

Cancer Care ◽

Care Quality ◽

Cancer Centers ◽

Report Quality ◽

Certified Cancer Centers

The authors outline a reporting program in use by an increasing number of certified cancer centers in Germany to report quality-of-care indicators.

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Patient-reported quality of care and pain severity in cancer

Palliative & Supportive Care ◽

10.1017/s1478951514000777 ◽

2014 ◽

Vol 13 (4) ◽

pp. 875-884 ◽

Cited By ~ 7

Author(s):

Kathryn A. Martinez ◽

Claire F. Snyder ◽

Jennifer L. Malin ◽

Sydney M. Dy

Keyword(s):

Quality Of Care ◽

Cancer Patients ◽

Nursing Care ◽

Care Coordination ◽

Symptom Burden ◽

Care Quality ◽

Pain Severity ◽

Physician Communication ◽

Patient Reported

AbstractObjective:Despite treatment availability, many cancer patients experience severe pain. Although patient assessments of care are increasingly employed to evaluate quality of care, little is known about its association with cancer symptom burden. The objective of our study was to examine the association between patient-reported quality of care and pain severity in a nationally representative cohort of cancer patients.Method:Quality of care was measured in three domains: physician communication, care coordination/responsiveness, and nursing care. Quality scores were dichotomized as optimal versus nonoptimal. Pain was measured on a scale of 0 (least) to 100 (worst). We utilized multivariable linear regression to examine the association between patient-reported quality of care and pain severity.Results:The analytic sample included 2,746 individuals. Fifty and 54% of patients, respectively, rated physician communication and care coordination/responsiveness as nonoptimal; 28% rated nursing care as nonoptimal. In adjusted models, rating physician communication as nonoptimal (versus optimal) was associated with a 1.8-point higher pain severity (p = 0.018), and rating care coordination/responsiveness as nonoptimal was associated with a 2.2-point higher pain severity (p = 0.006).Significance of results:Patient-reported quality of care was significantly associated with pain severity, although the differences were small. Interventions targeting physician communication and care coordination/responsiveness may result in improved pain control for some patients.

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Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.109 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 109-109

Author(s):

Andrea Eisen ◽

Jasmin Soobrian ◽

Ashley Tyrrell ◽

Clement Li ◽

Derek Muradali ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Performance Measurement ◽

Quality Indicators ◽

Cancer Care ◽

Evidence Based ◽

Breast Cancer Care ◽

Patient Journey ◽

The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

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Results of a feasibility analysis of quality indicators for outpatient cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6623 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6623-6623

Author(s):

Kerstin Hermes ◽

Walter Baumann ◽

Andreas Zimmermann ◽

Stephan H. Schmitz

Keyword(s):

Quality Of Care ◽

Quality Indicators ◽

Cancer Care ◽

High Standard ◽

Feasibility Analysis ◽

Internal Quality ◽

Quality Reporting ◽

The Rich ◽

Cancer Specialists

6623 Background: Quality indicators are increasingly used for measuring quality of care, for internal quality assurance, confidential benchmarking processes and anonymous quality reporting. The WINHO quality indicators project aims to develop and examine process quality measures for outpatient cancer care in Germany. This project is fully funded by the German Cancer Aid (Deutsche Krebshilfe). Currently, a set of 46 quality indicators exists. To gain better insights into what data can be retrieved from patient records and documentation systems in oncology practices, a feasibility analysis was conducted prior to data collection. Methods: 2176 questionnaires focusing on different aspects of the feasibility of quality indicators were sent to 295 doctors of WINHO partner practices. 1089 questionnaires were answered. Hence, for each of the 46 WINHO quality indicators 20 to 27 answers are available. Results: Although about 80% of the data required for the indicators are documented in patient charts, less than 30% of the data can be retrieved electronically. Particularly, data for indicators of the quality of pain management, holistic and palliative care often cannot be retrieved easily. By contrast, data on basal documentation, therapy planning and implementation are easier to obtain from patient charts. As a result, these indicators experience better evaluations by the office-based oncologists regarding frequency of occurrence, acceptance and reliability. However, high standard deviations show that documentation habits vary considerably within the group of office-based cancer specialists. Conclusions: Despite the large amount of data documented by oncologists in everyday practice, the information required to measure quality of care with indicators is complicated by low retrievability of data. Facilitating improved documentation and IT systems in oncology practices would ease the collection and examination of the rich information documented by office-based oncologists.

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Patient Navigation and the Quality of Breast Cancer Care: An Analysis of the Breast Cancer Care Quality Indicators

Annals of Surgical Oncology ◽

10.1245/s10434-012-2527-8 ◽

2012 ◽

Vol 19 (10) ◽

pp. 3251-3256 ◽

Cited By ~ 22

Author(s):

Joseph J. Weber ◽

Debra C. Mascarenhas ◽

Lisa S. Bellin ◽

Rachel E. Raab ◽

Jan H. Wong

Keyword(s):

Breast Cancer ◽

Quality Indicators ◽

Cancer Care ◽

Patient Navigation ◽

Care Quality ◽

Breast Cancer Care

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Concordance of Patient and Caregiver Reports on the Quality of Colorectal Cancer Care

Journal of Oncology Practice ◽

10.1200/jop.19.00136 ◽

2019 ◽

Vol 15 (11) ◽

pp. e979-e988

Author(s):

Rachel D. Havyer ◽

Michelle van Ryn ◽

Patrick M. Wilson ◽

Lauren R. Bangerter ◽

Joan M. Griffin

Keyword(s):

Colorectal Cancer ◽

Quality Of Care ◽

Cancer Care ◽

Secondary Analysis ◽

Care Quality ◽

Patient Reports ◽

Quality Ratings ◽

Caregiver Quality ◽

Very High

PURPOSE: We aimed to better understand how similarly patients with colorectal cancer and caregivers view care quality and to assess factors that may influence concordance. MATERIALS AND METHODS: We conducted a secondary analysis of paired patient and caregiver quality ratings of colorectal cancer care in three specific domains: surgery, chemotherapy overall, and chemotherapy nursing. Agreement was assessed with difference scores, concordance with Gwet second-order agreement statistics (AC2), and variation in agreement with stratified analyses. We examined whether the care experiences of patients and caregivers were associated with top-box (most-positive) ratings and examined variations in concordance on the basis of the presence of a top-box score. RESULTS: Four hundred seventeen patient-caregiver dyads completed the surveys. Quality-of-care ratings were positively skewed, with most dyads indicating top-box ratings. Patient and caregiver care experiences were highly associated with top-box ratings. Overall patient-caregiver concordance was very high for all three care domains (surgery: AC2, 0.87 [95% CI, 0.83 to 0.90]; chemotherapy overall: AC2, 0.84 [95% CI, 0.79 to 0.88]; chemotherapy nursing: AC2, 0.91 [95% CI, 0.87 to 0.94]). Stratified analyses of patient and caregiver characteristics did not identify any patterns that consistently affected concordance. The concordance statistic significantly decreased for all three outcomes ( P < .001), however, when the patient or caregiver assessed quality as anything other than top box. CONCLUSION: Caregiver and patient reports on care quality were highly concordant for top-box care and did not vary with patient or caregiver factors. Additional exploration is needed to identify reasons for increased variability when the quality scores were less than a top-box response.

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Development and testing of Australian prehospital care quality indicators: study protocol

BMJ Open ◽

10.1136/bmjopen-2020-038310 ◽

2020 ◽

Vol 10 (7) ◽

pp. e038310

Author(s):

Robin Pap ◽

Craig Lockwood ◽

Matthew Stephenson ◽

Paul Simpson

Keyword(s):

Quality Of Care ◽

Quality Indicators ◽

Study Protocol ◽

Care Setting ◽

Prehospital Care ◽

Scientific Evidence ◽

Research Capacity ◽

Care Quality ◽

Test Quality

IntroductionHistorically, ambulance services were established to provide rapid transport of patients to hospital. Contemporary prehospital care involves provision of sophisticated ‘mobile healthcare’ to patients across the lifespan presenting with a range of injuries or illnesses of varying acuity. Because of its young age, the paramedicine profession has until recently experienced a lack of research capacity which has led to paucity of a discipline-specific, scientific evidence-base. Therefore, the performance and quality of ambulance services has traditionally been measured using simple, evidence-poor indicators forming a deficient reflection of the true quality of care and providing little direction for quality improvement efforts. This paper reports the study protocol for the development and testing of quality indicators (QIs) for the Australian prehospital care setting.Methods and analysisThis project has three phases. In the first phase, preliminary work in the form of a scoping review was conducted which provided an initial list of QIs. In the subsequent phase, these QIs will be developed by aggregating them and by performing related rapid reviews. The summarised evidence will be used to support an expert consensus process aimed at optimising the clarity and evaluating the validity of proposed QIs. Finally, in the third phase those QIs deemed valid will be tested for acceptability, feasibility and reliability using mixed research methods. Evidence-based indicators can facilitate meaningful measurement of the quality of care provided. This forms the first step to identify unwarranted variation and direction for improvement work. This project will develop and test quality indicators for the Australian prehospital care setting.Ethics and disseminationThis project has been approved by the University of Adelaide Human Research Ethics Committee. Findings will be disseminated by publications in peer-reviewed journals, presentations at appropriate scientific conferences, as well as posts on social media and on the project’s website.

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Development of quality indicators for women at high risk for breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.264 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 264-264

Author(s):

Armin Shahrokni ◽

Patrick Youngwhan Chun ◽

Arash Naeim ◽

Erin M. O’Leary ◽

Antonia Petruse ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

High Risk ◽

Quality Indicators ◽

Task Force ◽

Care Quality ◽

Process Of Care ◽

Cancer Society ◽

High Risk Women

264 Background: Thousands of women are at higher risk for developing breast cancer because of personal (such as early menarche, nulliparity), familial (e.g. BRCAI and II gene mutations), or clinical risk factors (e.g. chest wall radiation). It is thought that many, if not most, of these high risk women are not currently recognized and therefore not offered approaches to risk mitigation and early diagnosis; however, there is currently no set of measures to evaluate the quality of care provided to these women. We aimed to develop valid and feasible process-of-care quality indicators (QIs) for care of women at high risk for breast cancer. Methods: 2,402 articles from 2002 to April of 2012 were found to be appropriate for our study by search on PubMed and Medline. Studies were included if they showed a relationship between care processes for the identification, detection and risk reduction of breast cancer in women at high risk of the disease. Two reviewers reviewed the abstracts and then full texts of articles, and reviewed guidelines from the American Cancer Society, US Preventive Services Task Force and the National Comprehensive Cancer Network guidelines in producing a monograph of evidence supporting proposed QIs. A multidisciplinary panel of clinicians reviewed the evidence and rated each proposed QI for validity and feasibility. They then convened for a face to face meeting to discuss disagreements and then re-rate the measures. Results: Of 36 proposed QIs, 18 QIs were judged as valid and feasible to measure quality of care provided to women at high risk of breast cancer. Four QIs focused on identification of high risk women and risk communication. Six QIs related to counseling and genetic testing. Four QIs aimed at early detection and four QIs related to risk reducing interventions. No physician intervention to change a woman’s life style was rated highly enough to be a quality of care measure. Conclusions: A set of 18 QIs for the care of women high risk for breast cancer was developed along with the supporting literature and these measures will be applied to identify whether there are areas of care in need of improvement.

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