Streamlining federally mandated quality metric reporting in cancer care.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 68-68
Author(s):  
Lisa M. Kidin ◽  
Ronald Stewart Walters ◽  
Doug Browning ◽  
Sarah H Taylor ◽  
Victoria S. Jordan
Keyword(s):  
Early Identification ◽  
Quality Care ◽  
Disease Process ◽  
Public Reporting ◽  
Quality Data ◽  
Cancer Centers ◽  
Quality Reporting ◽  
National Quality ◽  
Longitudinal Data Collection

68 Background: Public reporting has been an established process for non-PPS exempt hospitals since the inception of the Core Measures in 2001; however, Cancer Centers were not subject to public reporting and had no standardized established formal mechanism to collect, analyze and report clinical quality data until the Affordable Care Act (ACA) of 2010. The first three Clinical Process/Oncology Care Measures must be submitted through the American College of Surgeons Rapid Quality Reporting (RQRS) system. Since registries are designed to provide a retrospective snapshot of the patient population during the first four months of the disease process, the change to longitudinal data collection, while critical for intervention in time to improve concordance, is extremely difficult for cancer centers with large volumes and complex cases. Our institution created a collaborative interdisciplinary model utilizing quality management nurses to support and enhance the submission process by utilizing an early identification and intervention process. Methods: Prior to implementation, the average submission time for the initial three oncology specific metrics was eight months due to the significant effort to determine the analytic population based on our volume of patients. In addition, many patients receive treatments outside the facility with little or no documentation that often resulted in the inability to determine metric concordance. Results: The new process identified patients at two months and created a robust follow up and validation process utilizing a model to ensure evidence based care is provided across the continuum. This enabled monthly submission to RQRS at the end of three months and leveraged the system to ensure that patients had the appropriate therapy documented in the system. This process shortened the submission time to less than half and initial projections indicate increased overall compliance. Conclusions: We enhanced the process of submission for federally mandated measures to RQRS by initiating early identification and follow up. This significantly impacted our ability to accurately represent the high quality care provided at our institution and provide documented concordance with national quality measures.

Improving quality of care within the NCI Community Cancer Centers Program (NCCCP) network.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 178-178
Author(s):  
Kathleen M. Castro ◽  
Eliot Lawrence Friedman ◽  
Nadesa Mack ◽  
Robert D. Siegel ◽  
Jana Eisenstein ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Assessment Tool ◽  
Quality Care ◽  
Implementation Strategies ◽  
Multidisciplinary Care ◽  
Program Goal ◽  
Cancer Centers ◽  
Quality Reporting ◽  
National Quality

178 Background: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) was initiated to expand cancer research and deliver quality cancer care in communities. A program goal was support of quality care initiatives. Twenty-one community sites in 16 states participated in the network providing care to approximately 40,000 cancer patients/year. We describe strategies for implementation of a structured quality program within our network. Methods: Four components served as the foundation for quality efforts: 1) increasing multidisciplinary care (MDC) programs; 2) ASCO QOPI participation; 3) Commission on Cancer Rapid Quality Reporting System (RQRS) participation; and 4) expansion of genetic counseling/services. A Quality of Care subcommittee formed to guide quality efforts within the network. Clinicians from the network served as subcommittee leadership and each site designated a quality of care lead. The subcommittee met by teleconference monthly, developed goals, shared best practices, developed processes to accomplish goals and documented improvements in priority areas. Results: Strategies employed to improve quality included: assessment tool development, participation in national quality reporting initiatives, review and monitoring of network data, and network performance improvement projects. Conclusions: The NCCCP identified areas of needed quality improvement. In addition, the network developed implementation strategies and created benchmarks that measure program quality. Participants benefitted from the opportunity to interface with one another and set network goals, while adopting strategies to best fit their own practices and community sites. [Table: see text]

Defining high-quality NSCLC care at U.S. cancer centers.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 229-229
Author(s):  
Mark A. Socinski ◽  
Leigh Boehmer
Keyword(s):  
Quality Care ◽  
Steering Committee ◽  
Small Cell Lung ◽  
Patient Journey ◽  
Cancer Centers ◽  
Clinical Criteria ◽  
Multidisciplinary Practice ◽  
National Quality ◽  
Biomarker Testing ◽  
Care Guidelines

229 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on individual components of care and advocate multidisciplinary collaboration, guidance spanning the complete patient journey is lacking. We aimed to compile quality-focused recommendations for the multidisciplinary team and selected clinical criteria for ideal NSCLC care, and propose a new set of metrics encompassing the entire care continuum. These metrics would be used as a new benchmark for ideal NSCLC care via the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy to compile evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Quality recommendations were organized within key care areas of the patient journey: care coordination and patient education, diagnosis and biomarker testing, staging and treatment planning, and survivorship. Results: A total of 32 recommendations were included across the 4 key NSCLC care areas. Key quality recommendations are listed (Table). Conclusions: The full set of recommendations define ideal NSCLC care and serve as a valuable guide for multidisciplinary practice and quality improvement initiatives. [Table: see text]

What constitutes high-quality NSCLC care? Overarching quality considerations for improving NSCLC care at US cancer centers.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19181-e19181
Author(s):  
Mark A. Socinski ◽  
Leigh Boehmer
Keyword(s):  
Care Coordination ◽  
Quality Care ◽  
Multidisciplinary Care ◽  
Steering Committee ◽  
Patient Journey ◽  
Cancer Centers ◽  
Clinical Criteria ◽  
Multidisciplinary Practice ◽  
National Quality ◽  
Care Guidelines

e19181 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on specific individual components of care and advocate multidisciplinary collaboration, guidance on multidisciplinary care spanning the complete patient journey is lacking. Quality-focused recommendations for the multidisciplinary team, along with selected clinical criteria for ideal NSCLC care, were compiled, and a new set of metrics encompassing the entire care continuum was proposed. These metrics were used to set a new benchmark for ideal NSCLC care through the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy, who identified and compiled evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Ideal quality recommendations were organized within key care areas of the patient journey: care coordination, diagnosis, and treatment. Results: A total of 32 recommendations were included. Of these, 9 were key unpublished recommendations on NSCLC care, including diagnosis and biomarker testing, treatment planning, care coordination, and patient education (Table). Conclusions: These recommendations define the criteria for ideal NSCLC care and serve as a valuable resource to guide multidisciplinary practice and quality improvement initiatives. [Table: see text]

Fault Tree Analysis

2016 ◽  
Vol 32 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Lisa M. McElroy ◽  
Rebeca Khorzad ◽  
Theresa A. Rowe ◽  
Zachary A. Abecassis ◽  
Daniel W. Apley ◽  
...  
Keyword(s):  
High Reliability ◽  
Fault Tree ◽  
Fault Tree Analysis ◽  
Quality Data ◽  
Improvement Program ◽  
Surgical Quality ◽  
Tree Analysis ◽  
Quality Reporting ◽  
National Quality ◽  
Reporting Programs

The purpose of this study was to use fault tree analysis to evaluate the adequacy of quality reporting programs in identifying root causes of postoperative bloodstream infection (BSI). A systematic review of the literature was used to construct a fault tree to evaluate 3 postoperative BSI reporting programs: National Surgical Quality Improvement Program (NSQIP), Centers for Medicare and Medicaid Services (CMS), and The Joint Commission (JC). The literature review revealed 699 eligible publications, 90 of which were used to create the fault tree containing 105 faults. A total of 14 identified faults are currently mandated for reporting to NSQIP, 5 to CMS, and 3 to JC; 2 or more programs require 4 identified faults. The fault tree identifies numerous contributing faults to postoperative BSI and reveals substantial variation in the requirements and ability of national quality data reporting programs to capture these potential faults. Efforts to prevent postoperative BSI require more comprehensive data collection to identify the root causes and develop high-reliability improvement strategies.

The psychosocial matrix: A community-derived evaluative tool for designing quality psychosocial cancer care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 250-250
Author(s):  
Laura Pence Forsythe ◽  
Julia Howe Rowland ◽  
Lynne Padgett ◽  
Karyl Blaseg ◽  
Scott Siegel ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Assessment Tool ◽  
Quality Care ◽  
Psychosocial Care ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Cancer Centers ◽  
Future Aspirations ◽  
Essential Components

250 Background: Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, guidance regarding the essential components of comprehensive care or progressive steps for implementing each component is limited. This abstract presents a unique tool for self-assessing capacity to provide quality psychosocial care to cancer survivors and results of the first full-scale implementation of this tool. Methods: The psychosocial workgroup of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Psychosocial Care Matrix Assessment Tool which covers 7 domains (e.g., distress screening, patient-provider communication, evaluation of psychosocial programs). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 regarding their capacity for psychosocial care at entry into NCCCP (baseline), after two years of NCCCP participation (2007 sites only), and within the coming year (future aspirations). Results: At baseline, matrix responses reflected few or no systematic processes in place for most components of psychosocial care. However, reported capacity to deliver specific components improved at two years post-NCCCP entry for the 2007 sites and in all sites’ future aspirations. For example, about 80% of all sites reported no or inconsistent distress screening at baseline. After two years, 48% of the 2007 sites reported consistent screening with a standardized tool or consistent screening plus a comprehensive interview. Nearly all 2007 sites (89%) aspired to provide consistent screening plus comprehensive interview with 50% also hoping to add systematic follow-up screenings. The majority of 2010 sites (71%) aspired to provide consistent screening with a standardized tool. Conclusions: The psychosocial matrix tool was found to be useable and valuable. At the NCCCP sites, some aspects of psychosocial care (e.g., communicating the importance of psychosocial care) are more readily implemented than others (e.g., follow-up after a positive distress screen). With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help identify and develop steps to address gap areas.

Evaluation of medical care for Diabetic and Hypertensive patients in primary care in Mexico: Observational retrospective study (Preprint)

2020 ◽  
Author(s):  
Agustin Lara-Esqueda ◽  
Sergio A Zaizar-Fregoso ◽  
Violeta M Madrigal-Perez ◽  
Mario Ramirez-Flores ◽  
Daniel A Montes-Galindo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Serum Lipids ◽  
Quality Care ◽  
Premature Death ◽  
Current Standard ◽  
Anonymized Data ◽  
Quality Of Medical Care

BACKGROUND Diabetes Mellitus is a worldwide health problem and the leading cause of premature death with increasing prevalence over time. Usually, along with it, Hypertension presents and acts as another risk factor that increases mortality risk. Both diseases impact the country's health while also producing an economic burden for society, causing billions of dollars to be invested in their management. OBJECTIVE The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico, according to the official Mexican standard for each pathology. METHODS 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical records database, exported as anonymized data for research purposes. Each patient record was compared against the standard to test the quality of medical care. RESULTS Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease of diabetes or hypertension. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination in the whole population. Specialty referral reached 1% in angiology or cardiology in the whole population. CONCLUSIONS Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards. While patients with DM and HBP do not have a current standard to evaluate their own needs.

scholarly journals Cardiac Amyloidosis with Discordant QRS Voltage between Frontal and Precordial Leads

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 660
Author(s):  
Csilla-Andrea Eötvös ◽  
Roxana-Daiana Lazar ◽  
Iulia-Georgiana Zehan ◽  
Erna-Brigitta Lévay-Hail ◽  
Giorgia Pastiu ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Cardiac Amyloidosis ◽  
Ventricular Hypertrophy ◽  
Low Voltage ◽  
Disease Process ◽  
Left Ventricular ◽  
Clinical Suspicion ◽  
Immunoglobulin Light Chain ◽  
Different Types

Among the different types, immunoglobulin light chain (AL) cardiac amyloidosis is associated with the highest morbidity and mortality. The outcome, however, is significantly better when an early diagnosis is made and treatment initiated promptly. We present a case of cardiac amyloidosis with left ventricular hypertrophy criteria on the electrocardiogram. After 9 months of follow-up, the patient developed low voltage in the limb leads, while still maintaining the Cornell criteria for left ventricular hypertrophy as well. The relative apical sparing by the disease process, as well as decreased cancellation of the opposing left ventricular walls could be responsible for this phenomenon. The discordance between the voltage in the frontal leads and precordial leads, when present in conjunction with other findings, may be helpful in raising the clinical suspicion of cardiac amyloidosis.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

scholarly journals Structural and functional radiomics for lung cancer

2021 ◽  
Author(s):  
Guangyao Wu ◽  
Arthur Jochems ◽  
Turkey Refaee ◽  
Abdalla Ibrahim ◽  
Chenggong Yan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Strategy ◽  
Early Stage ◽  
Quality Data ◽  
Clinical Implementation ◽  
Early Stage Lung Cancer ◽  
Treatment Response Evaluation ◽  
Advanced Stage Lung Cancer ◽  
Stage Lung Cancer

Abstract Introduction Lung cancer ranks second in new cancer cases and first in cancer-related deaths worldwide. Precision medicine is working on altering treatment approaches and improving outcomes in this patient population. Radiological images are a powerful non-invasive tool in the screening and diagnosis of early-stage lung cancer, treatment strategy support, prognosis assessment, and follow-up for advanced-stage lung cancer. Recently, radiological features have evolved from solely semantic to include (handcrafted and deep) radiomic features. Radiomics entails the extraction and analysis of quantitative features from medical images using mathematical and machine learning methods to explore possible ties with biology and clinical outcomes. Methods Here, we outline the latest applications of both structural and functional radiomics in detection, diagnosis, and prediction of pathology, gene mutation, treatment strategy, follow-up, treatment response evaluation, and prognosis in the field of lung cancer. Conclusion The major drawbacks of radiomics are the lack of large datasets with high-quality data, standardization of methodology, the black-box nature of deep learning, and reproducibility. The prerequisite for the clinical implementation of radiomics is that these limitations are addressed. Future directions include a safer and more efficient model-training mode, merge multi-modality images, and combined multi-discipline or multi-omics to form “Medomics.”

Effects of the CMS’ Public Reporting Program for Inpatient Psychiatric Facilities on Targeted and Nontargeted Safety: Differences Between For-Profits and Nonprofits

2021 ◽  
pp. 107755872199892
Author(s):  
Morgan C. Shields
Keyword(s):  
Spillover Effect ◽  
Public Reporting ◽  
Unintended Consequences ◽  
Psychiatric Facility ◽  
Quality Reporting ◽  
Performance Reporting ◽  
Reporting Programs ◽  
Using Data ◽  
Inpatient Psychiatric Facility ◽  
Psychiatric Facilities

The Centers for Medicare and Medicaid Services implemented the Inpatient Psychiatric Facility Quality Reporting Program in 2012, which publicly reports facilities’ performance on restraint and seclusion (R-S) measures. Using data from Massachusetts, we examined whether nonprofits and for-profits responded differently to the program on targeted indicators, and if the program had a differential spillover effect on nontargeted indicators of quality by ownership. Episodes of R-S (targeted), complaints (nontargeted), and discharges were obtained for 2008-2017 through public records requests to the Commonwealth of Massachusetts. Using difference-in-differences estimators, we found no differential changes in R-S between for-profits and nonprofits. However, for-profits had larger increases in overall complaints, safety-related complaints, abuse-related complaints, and R-S-related complaints compared with nonprofits. This is the first study to examine the effects of a national public reporting program among psychiatric facilities on nontargeted measures. Researchers and policymakers should further scrutinize intended and unintended consequences of performance-reporting programs.

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