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

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.

Download Full-text

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.

Download Full-text

Improving Breast Cancer Quality of Care with the Use of Patient Navigators

The American Surgeon ◽

10.1177/000313481007601003 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1043-1046 ◽

Cited By ~ 9

Author(s):

Formosa Chen ◽

Cheryl Mercado ◽

Irina Yermilov ◽

Melissa Puig ◽

Clifford Y. Ko ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Quality Indicators ◽

Cancer Care ◽

Public Hospital ◽

Patient Navigator ◽

Financial Barriers ◽

Patient Navigators ◽

The Impact

The continuum of breast cancer care requires multidisciplinary efforts. Patient navigators, who perform outreach, coordination, and education, have been shown to improve some areas of care. However, little research has assessed the impact of navigators on breast cancer treatment in uninsured populations. Our objective is to report on the impact of a patient navigator program on breast cancer quality of care at a public hospital. One hundred consecutive newly diagnosed patients with breast cancer (Stages I to III) were identified (2005 to 2007). Forty-nine patients were treated before the use of navigators and 51 after program implementation. Nine breast cancer quality indicators were used to evaluate quality of care. Overall adherence to the quality indicators improved from 69 to 86 per cent with the use of patient navigators ( P < 0.01). Only one individual indicator, use of surveillance mammography, improved significantly (52 to 76%, P < 0.05). All nine indicators reached 75 per cent or greater adherence rates after implementation of the navigator program compared with only four before implementation. Patient navigators appear to improve breast cancer quality of care in a public hospital. In populations in which cultural, linguistic, and financial barriers are prevalent, navigator programs can be effective in narrowing the observed gaps in the quality of cancer care.

Download Full-text

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.

Download Full-text

Outcomes in rectal cancer care in Uruguay: A study on quality indicators.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.234 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 234-234

Author(s):

Santiago Fontes ◽

Megan Berry ◽

Ana Marín-Jiménez ◽

Juan Carlos Sánchez ◽

Graciela Reyes ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Treatment Outcomes ◽

Quality Indicators ◽

Rectal Carcinoma ◽

Cancer Care ◽

Diagnosis And Treatment ◽

Internal Quality ◽

Target Values

234 Background: For years, rectal cancer has been considered a model oncologic entity and significant therapeutic improvements have been made in the last two decades. However, evidence suggests there are important differences in quality of care between countries, institutions and teams. Therefore, population-based audits are of great importance to ensure quality cancer care. Quality indicators (QIs) provide information on safety and quality of cancer screening, diagnosis and treatment. Aim: To describe and analyze quality indicators for diagnosis and treatment of rectal carcinoma at a high-volume cancer center in Uruguay. Methods: A retrospective descriptive study was performed as a sub-analysis of a cohort of 971 patients. A total of 497 rectal or rectosigmoid-junction carcinoma patients treated between 2008 and 2020 at the Uruguayan National Cancer Institute were included. Previously validated target values formed the basis of the QIs used in this study. Each QI was reported as the proportion (% 95% CI) of patients fulfilling the criteria out of eligible patients. Kaplan–Meier method was used to calculate overall survival rates. Results: Mean age was 62 years, 59.5% were male, and 78% showed no evidence of disseminated disease at diagnosis. Diagnosis and staging: combined contrast-enhanced CT TAP scan was performed in 66% of the sample, 51% of cases had a total colonoscopy before elective curative intent surgery. Locoregional c-TN staging was assessed by high resolution MRI in 64% of cases. Only 30% and 63% of patients in the preoperatively irradiated and the nonirradiated groups had a minimum of 12 lymph nodes examined. Multimodal treatment: preoperative chemo-radiation was delivered for stages II and III middle/low-third rectal cancers in 81% of the cases. Adjuvant therapy was prescribed in 75% and 47% of stages III and II receiving surgery as upfront treatment, respectively. 78% of cStage IV patients received palliative chemotherapy. Surrogate indicators of outcome: 82% had distal tumor-free margins, although only 72% had a pathological circumferential radial margin ((y)pCRM) mentioned in the pathology report. Non-curative (R1,2) resections in M0 rectal carcinoma in our cohort was below the target value of <20%. 15% of our cases had a positive (y)pCRM. Treatment-outcomes: Our cumulative overall local recurrence was 12.6% and the 3-year overall survival rate was 84.8%. Conclusions: Continuous analysis of QIs in rectal cancer is necessary for internal quality management and for external quality assessment, to improve and compare treatment outcomes. Our results highlight the positive aspects of rectal cancer care at our center and reveal the weak points in diagnosis and treatment that need special attention. They will serve as a guide in the implementation of new strategies and programs that will aim to improve safety and quality of rectal cancer care for Uruguayan patients, regardless of where they live or are treated.

Download Full-text

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

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.187 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R A Cocchiara ◽

L Lia ◽

B Dorelli ◽

A Mannocci ◽

M Follmann ◽

...

Keyword(s):

Quality Of Care ◽

Cancer Patients ◽

Quality Indicators ◽

Cancer Care ◽

Care Quality ◽

Evaluation Tool ◽

Step Process ◽

Methodological Tool ◽

Selection Of

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.

Download Full-text

The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3175 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Raparelli ◽

L Pilote ◽

H Behlouli ◽

J Dziura ◽

H Bueno ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Quality Of Care ◽

Healthcare System ◽

Quality Indicators ◽

Funding Source ◽

Post Discharge ◽

Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

Download Full-text

Multidisciplinary Cancer Care With a Patient and Physician Satisfaction Focus

Journal of Oncology Practice ◽

10.1200/jop.2010.000028 ◽

2010 ◽

Vol 6 (6) ◽

pp. e35-e37 ◽

Cited By ~ 24

Author(s):

Gregory Litton ◽

Dianne Kane ◽

Gina Clay ◽

Patricia Kruger ◽

Thomas Belnap ◽

...

Keyword(s):

Quality Of Care ◽

Cancer Care ◽

Physician Satisfaction ◽

Care Process ◽

Multidisciplinary Clinic ◽

Intermountain Healthcare ◽

Multidisciplinary Clinics

If implemented appropriately, multidisciplinary clinics can enhance quality of care and increase downstream revenue. The multidisciplinary clinic at Intermountain Healthcare has greatly improved the cancer care process for patients, physicians, and the community.

Download Full-text

Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

Journal of Clinical Oncology ◽

10.1200/jco.2007.15.8253 ◽

2008 ◽

Vol 26 (23) ◽

pp. 3860-3866 ◽

Cited By ~ 516

Author(s):

Craig C. Earle ◽

Mary Beth Landrum ◽

Jeffrey M. Souza ◽

Bridget A. Neville ◽

Jane C. Weeks ◽

...

Keyword(s):

Quality Of Care ◽

End Of Life ◽

Cancer Care ◽

Aggressive Treatment ◽

Care Issue ◽

Open Question

The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

Download Full-text

Incarceration and Cancer-Related Outcomes (ICRO) study protocol: using a mixed-methods approach to investigate the role of incarceration on cancer incidence, mortality and quality of care

BMJ Open ◽

10.1136/bmjopen-2021-048863 ◽

2021 ◽

Vol 11 (5) ◽

pp. e048863

Author(s):

Lisa Puglisi ◽

Alexandra A Halberstam ◽

Jenerius Aminawung ◽

Colleen Gallagher ◽

Lou Gonsalves ◽

...

Keyword(s):

Socioeconomic Status ◽

Quality Of Care ◽

Mixed Methods ◽

Cancer Incidence ◽

Cancer Care ◽

Survival Models ◽

Structural Racism ◽

Interaction Terms ◽

The Relationship

IntroductionIncarceration is associated with decreased cancer screening rates and a higher risk for hospitalisation and death from cancer after release from prison. However, there is a paucity of data on the relationship between incarceration and cancer outcomes and quality of care. In the Incarceration and Cancer-Related Outcomes Study, we aim to develop a nuanced understanding of how incarceration affects cancer incidence, mortality and treatment, and moderates the relationship between socioeconomic status, structural racism and cancer disparities.Methods and analysisWe will use a sequential explanatory mixed-methods study design. We will create the first comprehensive linkage of data from the Connecticut Department of Correction and the statewide Connecticut Tumour Registry. Using the linked dataset, we will examine differences in cancer incidence and stage at diagnosis between individuals currently incarcerated, formerly incarcerated and never incarcerated in Connecticut from 2005 to 2016. Among individuals with invasive cancer, we will assess relationships among incarceration, quality of cancer care and mortality, and will assess the degree to which incarceration status moderates relationships among race, socioeconomic status, quality of cancer care and cancer mortality. We will use multivariable logistic regression and Cox survival models with interaction terms as appropriate. These results will inform our conduct of in-depth interviews with individuals diagnosed with cancer during or shortly after incarceration regarding their experiences with cancer care in the correctional system and the immediate postrelease period. The results of this qualitative work will help contextualise the results of the data linkage.Ethics and disseminationThe Yale University Institutional Review Board (#2000022899) and the Connecticut Department of Public Health Human Investigations Committee approved this study. We will disseminate study findings through peer-reviewed publications and academic and community presentations. Access to the deidentified quantitative and qualitative datasets will be made available on review of the request.

Download Full-text