Model of quality care indicators for patients with colorectal, lung, and breast cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 241-241
Author(s):  
Eduardo Diaz-Rubio
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Quality Care ◽  
Care Quality ◽  
Histological Diagnosis ◽  
Diagnosis And Treatment ◽  
Concomitant Chemoradiotherapy ◽  
Elapsed Time ◽  
Initial Staging

241 Background: The care of an oncology patient is a complex process with important clinical, social and financial repercussions. The purpose of this work is to develop quality care indicators for the medical care of patients with cancer. It is fundamental that health organisations adopt such models based on quality standards with the intention to promote excellence in the care of cancer patients. Methods: Research for scientific evidence, revision and selection of standards using the Delphi method was employed and definition of indicators was established. Results: 50 quality indicators were created directed to: Organisation: Multidisciplinary committees; informed consent; patient security; elapsed time between diagnosis and treatment; tumour registry; treatment protocols. Colorectal cancer: Histopathology report and markers; chemotherapy for advanced/metastatic cancer; evaluation of staging of colorectal cancer; liver metastases; adjuvant chemotherapy; evaluation of history family; biological therapy and RAS gene mutation; radiotherapy; quality of surgical notes. Breast cancer: Histopathology report and markers; initial staging; hormonotherapy; other treatments; elapsed time between histological diagnosis and treatment and between surgery and adjuvant treatment; pre-operative assessment and conservative surgery focused on the armpit; access availability to initial radiological studies.Lung cancer: Histopathology report and markers; initial staging; elapsed time between histological diagnosis and treatment; concomitant chemoradiotherapy; evaluation of chemotherapy response; adjuvant chemotherapy; elapsed time till the completion of staging; surgery; chemotherapy with good functional status; adjuvant radiotherapy; concomitant chemoradiotherapy for small cell lung cancer. End of life: Organisation of palliative care; outpatient attention; identify patients; access to care; pain management; information availability; psycosociological support; constipation management; counselling of family after death. Conclusions: The indicators constitute a reference model based on standards in order to measure care quality and to compare achieved results among health institutions.

scholarly journals Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 47s-47s
Author(s):  
R. Bergin ◽  
J. Emery ◽  
R. Bollard ◽  
A. Falborg ◽  
H. Jensen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Health System ◽  
Diagnosis And Treatment ◽  
Cancer Type ◽  
Symptom Screening ◽  
Rural And Urban ◽  
Time To Diagnosis ◽  
Rural Patients ◽  
Diagnostic Intervals

Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.

Measurement of quality of care for adjuvant chemotherapy of colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6071-6071
Author(s):  
M. Morse ◽  
R. Prosnitz ◽  
C. Mantyh ◽  
D. Fisher ◽  
G. Samsa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Quality Care ◽  
Future Research ◽  
Inclusion Criteria ◽  
Policy Makers ◽  
Leverage Points ◽  
Stage Iii Colon Cancer ◽  
Crucial Component

6071 Background: Although adjuvant chemotherapy (CT) is a crucial component of the therapy for stage III colon cancer and stage II and III rectal cancer patients, little is known about how best to measure whether quality care is being delivered. We sought to provide policy-makers and stake-holders with an inventory of the available measures and their usefulness. Methods: The MEDLINE and Cochrane databases were searched for all publications which might contain quality measures (QMs) pertaining to the diagnosis and treatment of patients with colorectal cancer (CRC). Our analysis was confined to QMs pertaining to adjuvant CT for CRC, based on US data, and published after 1990. Identified QMs were quantitatively rated based on the concepts of importance/usability, scientific acceptability, and validity or how well they had been tested. Results: 3,429 abstracts were reviewed, of which 843 articles underwent full text evaluation. Ultimately 74 articles met the established inclusion criteria for containing QMs, 32 of which pertained to adjuvant CT. These 32 articles contained 10 QMs, 8 of which had major flaws limiting their applicability. The two most ideal measures are presented in the table . Among the reasons some measures did not rate highly was the failure to utilize standard staging definitions or reliance on administrative inpatient databases, which do not account for chemotherapy administered on an out-patient basis. Conclusions: Very few measures of the quality of adjuvant CT for CRC have been published to date and fewer rate highly with regard to the concepts of importance/usability, scientific acceptability, and validity. Future research should focus on refining existing QMs and on developing new QMs which target important leverage points with respect to the provision of adjuvant therapy for CRC. [Table: see text] [Table: see text]

Assessing the validity of using claims data compared to medical chart reviews for measuring care quality in Japan.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 264-264
Author(s):  
Nana Nakamoto ◽  
Fumiaki Nakamura ◽  
Takahiro Higashi ◽  
Momoko Iwamoto ◽  
Asuka Amano ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Medical Record ◽  
Claims Data ◽  
Care Quality ◽  
Quality Performance ◽  
Gastric Cancer Patients

264 Background: Health insurance claims data have been used extensively as a less labor-intensive method of collecting data than medical record reviews, which are the preferred source of data collection in most medical studies. Although recent reports have raised questions about its validity of use in measuring care quality, validity of using claims data may differ by health systems and should therefore be assessed by country. We aimed to test the validity of using claims data in Japan by comparing quality performance scores obtained from claims data to those derived from medical record reviews. Methods: We reviewed medical records from Apr 2013 to Apr 2014 of gastric and colorectal cancer patients who were diagnosed in 2011 from 4 cancer care hospitals in Okinawa. We calculated the proportion of patients who received adjuvant chemotherapy for gastric and colorectal cancer using claims data, and compared the results with those obtained from medical record reviews. Chart reviews were performed by certified tumor registrars. We used kappa coefficients to measure the level of agreement between claims data and medical record reviews. Results: Analysis using claims data resulted in 14 Stage II and III gastric cancer patients who had undergone surgery, with 50% receiving adjuvant chemotherapy; whereas medical record reviews resulted in 19 patients, 94.7% of whom either received or had a clinically valid rationale for not undergoing adjuvant therapy. For colorectal patients, claims data resulted in 48.5% of 68 surgical stage III colorectal patients receiving adjuvant therapy, compared to 74.4% of 78 patients using medical record reviews who either received adjuvant therapy or had a valid reason for not undergoing therapy. Agreement between claims data and chart reviews was low (kappa=0.14) for gastric cancer, but fair (kappa =0.37) for colorectal cancer. Conclusions: Our analysis showed that use of claims data may greatly underestimate quality performance measures if they are not compensated by medical record reviews. Claims data alone cannot capture a large proportion of patients who either choose not to, or has a clinically valid reason for not undergoing standard care.

Breast cancer patients' perceived quality of care: The importance of trust and communication

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6554-6554
Author(s):  
R. Franco ◽  
K. P. Joseph ◽  
K. Fei ◽  
N. Bickell
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Care ◽  
Perceived Quality ◽  
Care Quality ◽  
Physician Communication ◽  
Breast Cancer Patients ◽  
Perceived Quality Of Care ◽  
Excellent Care

6554 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients’ perceived quality of cancer care matter. We undertook this study to assess predictors of women's ratings of the quality of their breast cancer care. Methods: 210 of 300 eligible women with stage I or II breast cancer at 1 of 8 participating NYC hospitals were enrolled in our survey: 43 (20%) were African-American (AA), 85 (40%) were white, and 63 (30%) were Hispanic and 19 (9%) were other races. All patients were telephone-surveyed to assess care experiences, knowledge, attitudes & beliefs about breast cancer and its treatment. Trust is based on a validated instrument and calibrated to a 100 point scale (Cronbach α = 0.73). A scale of 5 items assessing physician communication was created and calibrated to100 points (Cronbach α = 0.83). Results: Only 55% of women rated their quality of cancer care as excellent. Compared to women who did not rate their care as excellent, those who did had greater trust in their physician (p < 0.0001), better communication with their physician (p < 0.0001), indicated that were treated well by their physicians’ office staff (p = 0.01), and knew which physician to ask when they had questions (p = 0.0001); age, education & income were not significantly related to patient report of excellent care. AA women were least likely to rate their care as excellent (p = 0.004). AA women had lower levels of trust in their physician (p = 0.02). Patients reporting greater levels of communication also had greater trust (r = 0.38; p < 0.0001). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to and how well the staff treated the patient found that being AA (aRR = 0.47; 95% CI: 0.21–0.88), having greater trust (aRR = 1.72; 95% CI:1.49–1.85) and better communication (aRR = 1.38; 95% CI: 1.03–1.65) were significantly associated with patient perception of excellent quality care (p < 0.0001). Conclusions: Greater levels of physician communication about treatment and patient trust of their physician affect women's ratings of excellent cancer care quality. Efforts should be made to improve physician communication about treatment, particularly among AA women, to improve levels of trust and ratings of cancer care quality. No significant financial relationships to disclose.

scholarly journals Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

2019 ◽  
pp. 1-16
Author(s):  
Daniel S. O’Neil ◽  
Wenlong Carl Chen ◽  
Oluwatosin Ayeni ◽  
Sarah Nietz ◽  
Ines Buccimazza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
South African ◽  
Hormone Receptor ◽  
Cancer Care ◽  
Care Quality ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
Breast Cancer Care

PURPOSE The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.

scholarly journals Breast Cancer Care Quality Indicators in Spain: A Systematic Review

2021 ◽  
Vol 18 (12) ◽  
pp. 6411
Author(s):  
Marta Maes-Carballo ◽  
Yolanda Gómez-Fandiño ◽  
Carlos Roberto Estrada-López ◽  
Ayla Reinoso-Hermida ◽  
Khalid Saeed Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Cancer Care ◽  
Clinical Pathways ◽  
Primary Care Patient ◽  
Data Extraction ◽  
Quality Care ◽  
Care Patient ◽  
Care Quality ◽  
Breast Cancer Care

Breast cancer (BC) management care requires an increment in quality. An initiative to improve the BC quality care is registered, and quality indicators (QIs) are studied. We appraised the appearance of QIs and their standards systematically in Spain. A prospective systematic search (Prospero no: CRD42021228867) for clinical pathways and integrated breast cancer care processes was conducted through databases and the World Wide Web in February 2021. Duplicate data extraction was performed with 98% reviewer agreement. Seventy-four QIs (QI per document mean: 11; standard deviation: 10.59) were found in 15 documents. The Catalonian document had the highest number of QIs (n = 30). No QI appeared in all the documents. There were 9/74 QIs covering structure (12.16%), 53/74 covering process (71.62%), and 12/74 covering outcome (16.22%). A total of 22/66 (33.33%) process and outcome QIs did not set a minimum standard of care. QIs related to primary care, patient satisfaction, and shared decision making were deficient. Most of the documents established a BC QI standard for compliance, but the high variability hinders the comparison of outcomes. Establishing a consensus-based set of QIs needs urgent attention.

scholarly journals Examining Potential Colorectal Cancer Care Disparities in the Veterans Affairs Health Care System

2013 ◽  
Vol 31 (28) ◽  
pp. 3579-3584 ◽  
Author(s):  
Leah L. Zullig ◽  
William R. Carpenter ◽  
Dawn Provenzale ◽  
Morris Weinberger ◽  
Bryce B. Reeve ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Racial Disparities ◽  
Racial Differences ◽  
Medical Oncology ◽  
Quality Care ◽  
Veterans Affairs ◽  
Care Quality ◽  
Surveillance Colonoscopy ◽  
Explanatory Variables ◽  
Causal Pathways

Purpose Racial disparities in cancer treatment and outcomes are a national problem. The nationwide Veterans Affairs (VA) health system seeks to provide equal access to quality care. However, the relationship between race and care quality for veterans with colorectal cancer (CRC) treated within the VA is poorly understood. We examined the association between race and receipt of National Comprehensive Cancer Network guideline–concordant CRC care. Patients and Methods This was an observational, retrospective medical record abstraction of patients with CRC treated in the VA. Two thousand twenty-two patients (white, n = 1,712; African American, n = 310) diagnosed with incident CRC between October 1, 2003, and March 31, 2006, from 128 VA medical centers, were included. We used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for stages II and III, fluorouracil-based adjuvant chemotherapy for stage III, and surveillance colonoscopy for stages I to III). Explanatory variables included demographic and disease characteristics. Results There were no significant racial differences for receipt of guideline-concordant CRC care. Older age at diagnosis was associated with reduced odds of medical oncology referral and surveillance colonoscopy. Presence of cardiovascular comorbid conditions was associated with reduced odds of medical oncology referral (odds ratio, 0.65; 95% CI, 0.50 to 0.89). Conclusion In these data, we observed no evidence of racial disparities in CRC care quality. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.

Colorectal cancer knowledge and screening rates are lower than for breast cancer even in individuals at high risk of cancer

2001 ◽  
Vol 120 (5) ◽  
pp. A741-A741
Author(s):  
P ANG ◽  
D SCHRAG ◽  
K SCHNEIDER ◽  
K SHANNON ◽  
J JOHNSON ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
High Risk ◽  
Cancer Knowledge ◽  
Risk Of Cancer
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