Cancer care transparency: Trying to move the dial in California.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 85-85
Author(s):  
Stephanie Teleki
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Quality Measurement ◽  
State Level ◽  
Public Reporting ◽  
Care Quality ◽  
The State ◽  
Registry Data ◽  
Discharge Data ◽  
Analytic Work

85 Background: In 2012, approximately 140,000 patients (more than 16 new cases each hour) were diagnosed with cancer in California. Yet there is little useful information about the quality of cancer care to help patients, providers and payers make decisions about care. Methods: In 2012, the California HealthCare Foundation, an Oakland-based independent nonprofit philanthropy, launched an initiative focused on improving cancer care quality measurement and public reporting in the State. Since then, the Foundation has funded a number of projects aimed at filling information gaps: development of an interactive map and reports with data about the variation of care for breast and prostate cancer in California using State discharge and registry data (May 2013); development of a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience of cancer care survey instrument (with NCI and AHRQ, in progress); exploratory analytic work to determine the feasibility of measuring and reporting the number of cancer procedures performed by hospitals using State discharge data, for procedures where there is an established volume-outcome link (with Stanford University, in progress); exploratory analytic work to determine the feasibility of measuring cancer care quality at the medical group level in California (with Integrated Healthcare Association; in progress); a report on cancer care spending in California (with Dana Farber, in progress). Results: Significant challenges exist at the state level to provide information for improved decision-making about cancer care. Among them: access to data, especially cancer registry data that importantly includes detailed diagnostic information; lack of clinical outcome and patient experience measures; time needed to engage partners; and costs of carrying out quality measurement projects. Conclusions: This presentation would review efforts underway in California, providing a view of the challenges and opportunities at the state level for cancer quality measurement and public reporting. This presentation could be conceived as part of an interactive break-out session with 1-2 other panelists with real-world experience.

Cancer care transparency: Trying to move the dial in California.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 256-256
Author(s):  
Stephanie Teleki
Keyword(s):  
Cancer Registry ◽  
Cancer Care ◽  
Quality Measurement ◽  
State Level ◽  
Public Reporting ◽  
Care Quality ◽  
The State ◽  
Cancer Registry Data ◽  
California Cancer Registry ◽  
Challenges And Opportunities

256 Background: Each year in California, about 150,000 patients (more than 16 each hour) are diagnosed with cancer. Yet there is little useful information about the quality of cancer care to help patients, providers and payers make decisions about care. Methods: In 2012, the California HealthCare Foundation, an Oakland-based independent nonprofit philanthropy, launched an initiative focused on improving cancer care quality measurement and public reporting in the State. Since then, the Foundation has funded a number of projects aimed at filling information gaps; 2014 highlights include: (1) development of a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience of cancer care survey (with NCI and AHRQ). CHCF is now funding 6 community oncology test sites in California; (2) analytic work to measure and report the number of cancer procedures performed by hospitals using State discharge data, for procedures where there is an established volume-outcome link; public reporting by hospital expected by early 2015 (with Stanford University); (3) a feasibility study of measuring cancer care quality at the medical group level in California using claims data combined with California Cancer Registry data (with Integrated Healthcare Association); (4) a report on cancer care spending in California, publication expected Winter 2014 (with Dana Farber); (5) a workgroup of State and national thought leaders to contemplate and articulate the challenges and opportunities of leveraging the California Cancer Registry for quality measurement and public reporting; Sacramento briefing to state legislators in Winter 2014 (with UCSF). Results: Significant challenges exist at the state level to provide information for improved decision-making about cancer care. Among them: access to data, especially cancer registry data that importantly includes detailed diagnostic information; lack of clinical outcome and patient experience measures; time needed to engage partners; and costs of carrying out quality measurement projects. Conclusions: This presentation will provide a 2014 update on efforts underway in California, focused especially on the challenges and opportunities at the state level for cancer quality measurement and public reporting.

Linking commercial claims and state registry data to assess cancer care quality at the medical group level: Early lessons from California.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 269-269
Author(s):  
Ann Woo ◽  
Kathleen A. Foley
Keyword(s):  
Cancer Care ◽  
Quality Measures ◽  
Public Reporting ◽  
Care Quality ◽  
Registry Data ◽  
Data Sets ◽  
Medical Group ◽  
Group Level ◽  
Physician Group ◽  
Technical Specifications

269 Background: The Integrated Healthcare Association (IHA) is a non-profit organization which runs the largest Pay for Performance program in California. We describe a feasibility study to apply NQF cancer quality measures to linked commercial claims and state registry data and calculate results at the physician organization level. We describe phase I of the study: identifying appropriate measures and securing access to the data. Methods: We requested technical specifications for 9 NQF breast and colon cancer quality measures from the measure stewards and 2009 –2012 claims data from 7 California health plans. Results: Two barriers were identified in phase I: First, California Cancer Registry (CCR) data policies, designed for public health surveillance and not quality measurement, caused delays and present hurdles to public reporting. CCR data is not available until it is at least 95% complete, so 2011 data was not available until October 2013. Moreover, CCR requires that they conduct the data linkage, which required new data use agreements between the data aggregator and each participating insurer – costly in both time and legal fees. Finally, obstacles to public reporting any of the CCR data at the provider level still exist. Barrier 2: NQF measure specifications for linked claims-registry data sets do not currently exist, so the project team developed them, adding to the problem of proliferating non-harmonized quality measures. Conclusions: While the application of NQF measures to claims-registry linkage appears feasible for measurement of cancer care quality at the medical group level, registry policies and the lack of standard technical specifications for linked claims-registry data sets adversely impact the timeliness, usability, and comparability of results using two widely available data sources. More flexible policies on the part of data registries and attention to measure harmonization could improve data quality and usability for cancer care quality assessment and public reporting, and should be considered. In phase 2, we will apply the measures at the physician group level, and assess the feasibility of public reporting at the physician group level.

scholarly journals Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

2020 ◽  
pp. 1446-1454
Author(s):  
Lydia E. Pace ◽  
Lauren E. Schleimer ◽  
Cyprien Shyirambere ◽  
André Ilbawi ◽  
Jean Marie Vianney Dusengimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Delphi Process ◽  
Sub Saharan Africa ◽  
Breast Cancer Care ◽  
Modified Delphi ◽  
Sub Saharan

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

Self-reported patient experience and quality of care among elderly patients with colon cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 33-33 ◽  
Author(s):  
Rebecca A Snyder ◽  
Rebecca Wardrop ◽  
Alexander Mclain ◽  
Alexander A. Parikh ◽  
Anna Cass
Keyword(s):  
Health Care ◽  
Patient Experience ◽  
Cancer Care ◽  
Health Care Quality ◽  
Care Quality ◽  
Stage I ◽  
Stage Iii ◽  
Experience Of Care ◽  
Patient Reported

33 Background: Although studies have identified demographic and clinical factors associated with quality colorectal cancer care, the association between patient-reported experience of care and quality of care is unknown. Our primary aim was to assess the relationship between patient-reported experience of care and receipt of guideline-concordant colon cancer (CC) treatment. Methods: Fee-For-Service Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER registry and Consumer Assessment of Healthcare Providers and Systems patient experience survey (SEER-CAHPS) dataset. Patient-reported ratings were compared based on receipt of care consistent with recommended treatment guidelines [resection of ≥ 12 lymph nodes (LN) (stage I-III) and receipt of adjuvant chemotherapy (stage III)]. Linear regression was performed to compare mean patient experience scores by receipt of guideline concordant care, adjusting for patient and hospital factors. Results: 1010 patients with stage I-III CC were identified (mean age 76.7, SE 6.9). Of these, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 LN and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported ratings of health care quality, personal and specialty physicians, customer service, physician communication, getting needed care, and getting care quickly were similar among patients who received guideline-concordant treatment compared to those who did not. However, mean ratings of overall health care quality [91.3 (SE 2.0) vs. 82.4 (SE 1.7), p = 0.0004] and getting needed care [92.8 (SE 2.4) vs. 86.8 (SE 2.0), p = 0.047] were higher among stage III patients who received guideline concordant care compared to those who did not. Conclusions: Patient-reported ratings of health care quality and ability to get needed care are associated with guideline concordant cancer care among elderly patients with stage III CC. Further investigation is needed to determine if patient-reported experience correlates with other clinical measures of quality of colorectal cancer care.

Assessing Cancer Care at the State Level

2005 ◽  
Vol 27 (7) ◽  
pp. 4-8
Author(s):  
Joseph V. Simone
Keyword(s):  
Cancer Care ◽  
State Level ◽  
The State

scholarly journals Facts and Fears in Public Reporting: Patients’ Information Needs and Priorities When Selecting a Hospital for Cancer Care

2019 ◽  
Vol 39 (6) ◽  
pp. 632-641
Author(s):  
Susan Chimonas ◽  
Elizabeth Fortier ◽  
Diane G. Li ◽  
Allison Lipitz-Snyderman
Keyword(s):  
Cancer Treatment ◽  
Clinical Outcomes ◽  
Cancer Care ◽  
Information Needs ◽  
Public Reporting ◽  
Care Quality ◽  
Comparative Data ◽  
Report Cards ◽  
Information Preferences

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.

Survival as a measure of quality of cancer care and advances in therapy: Lessons learned from analyses of the National Cancer Data Base (NCDB).

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 173-173 ◽  
Author(s):  
Lawrence N. Shulman ◽  
Bryan E. Palis ◽  
Ryan M. McCabe ◽  
E. Greer Gay ◽  
Katherine Mallin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Pancreatic Cancer ◽  
Survival Data ◽  
Cancer Care ◽  
Care Quality ◽  
Lessons Learned ◽  
Registry Data ◽  
High Survival ◽  
Cancer Data ◽  
New Treatment

173 Background: Many quality metrics of cancer care are process measures, based on whether a patient received recommended treatment for diagnosis and stage of their disease. Survival is dependent on patient characteristics, disease specifics, and care received (surgery, systemic therapies, radiation). Some argue survival is the ultimate measure of cancer care quality. Survival calculated from registry data may be a better indication of the real effects of new therapies as it contains a broad representation of patients who may not meet the eligibility criteria for clinical trials. Methods: The NCDB is composed of registry data from approximately 1,500 hospital based cancer programs, and includes stage, demographic data, co-morbidities, treatments, and vital status. Survival analyses were derived from NCDB data for all stages of breast cancer, non-small cell lung cancer (NSCLC), and pancreatic cancer. These diseases were selected because breast cancer has a high survival rate, whereas NSCLC and pancreatic cancer are diseases with a poor prognosis, but recent advances may have improved survival. Un-adjusted and risk adjusted survival were analyzed by socioeconomic, tumor, and hospital factors including stage, comorbidities, diagnosis year (to assess new treatment trends), and type of institution (academic, comprehensive community, and community cancer programs). Results: Results for these diseases and variables noted will be presented. Whereas better un-adjusted survival rates were often seen at academic cancer programs, differences disappeared after risk-adjustment. Improved survival was seen in more recent years, probably representing new treatment effects, though gains were modest and stage dependent. Conclusions: Measuring survival across hospitals and regions is critical to understanding the state of cancer treatment nationally and the effect of quality and therapy advances on patients across a variety of clinical settings. Methodologic challenges in analyzing and interpreting survival data must be realized, and continued innovation in the collection and analysis of data is needed.

scholarly journals The present and future of quality measures and public reporting in neurosurgery

2015 ◽  
Vol 39 (6) ◽  
pp. E3 ◽  
Author(s):  
Kimon Bekelis ◽  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Christopher M. Holland ◽  
Jason Davies ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Reporting System ◽  
Quality Measurement ◽  
Quality Measures ◽  
Public Reporting ◽  
Care Quality ◽  
Common Denominator ◽  
Quality Reporting ◽  
Physician Quality Reporting System

Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare’s Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet “generic” quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control. The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs. Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care solutions, and actively participate in meaningful quality initiatives for the benefit of the patients served.

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