National Quality Measures for Breast Centers (NQMBC): A Robust Quality Tool

Abstract Background Quality measures are effective tools to improve patient outreach, retention in care, adherence, and outcomes. This study benchmarks National Quality Forum–endorsed HIV quality measures in a US clinical cohort. Methods This observational study utilized prospectively captured data from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) database over 2014−2016 to assess quality measure achievement among patients with HIV in terms of medical visit frequency (#2079), medical visit gaps (#2080), viral suppression (#2082), and antiretroviral therapy (ART) prescriptions (#2083). The proportion of patients meeting each measure was calculated. Generalized estimating equations assessed trends in measure achievement. Results The OPERA sample included 23 059−42 285 patients with similar demographics and characteristics across measurement periods. Overall, 62%−66% of patients met the visit frequency measure (#2079), 81%−85% had no gaps between visits (#2080), 71%−73% achieved viral suppression (#2082), and 92%−94% were prescribed ART (#2083). The adjusted odds of achieving viral suppression and being prescribed ART increased over time by 3% and 19%, respectively, despite a significant decline in patient engagement (16% for #2079, 25% for #2080). Patients <30 years of age were significantly less likely to meet all measures than older patients (P < .0001), with particularly low levels of engagement. Measure achievement also varied by gender, ethnicity, region, and select clinical characteristics. Conclusions Despite gains in the rate of ART prescription and viral suppression, there remains room for improvement in the care of patients with HIV. Strategies for quality improvement may be more effective if tailored by age group.

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Pediatric-Specific End-of-Life Care Quality Measures: An Unmet Need of a Vulnerable Population

Journal of Oncology Practice ◽

10.1200/jop.2017.021766 ◽

2017 ◽

Vol 13 (10) ◽

pp. e874-e880 ◽

Cited By ~ 6

Author(s):

Emily E. Johnston ◽

Abby R. Rosenberg ◽

Arif H. Kamal

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Quality Measures ◽

Care Quality ◽

Patient Choice ◽

Decision Makers ◽

Hospital Death ◽

Life Care ◽

High Quality ◽

National Quality

We must ensure that the 20,000 US children (age 0 to 19 years) who die as a result of serious illness annually receive high-quality end-of-life care. Ensuring high-quality end-of-life care requires recognition that pediatric end-of-life care is conceptually and operationally different than that for adults. For example, in-hospital adult death is considered an outcome to be avoided, whereas many pediatric families may prefer hospital death. Because pediatric deaths are comparatively rare, not all centers offer pediatric-focused palliative care and hospice services. The unique psychosocial issues facing families who are losing a child include challenges for parent decision makers and young siblings. Furthermore, the focus on advance directive documentation in adult care may be less relevant in pediatrics because parental decision makers are available. Health care quality measures provide a framework for tracking the care provided and aid in agency and provider accountability, reimbursement, and educated patient choice for location of care. The National Quality Forum, Joint Commission, and other groups have developed several end-of-life measures. However, none of the current quality measures focus on the unique needs of dying pediatric patients and their caregivers. To evolve the existing infrastructure to better measure and report quality pediatric end-of-life care, we propose two changes. First, we outline how existing adult quality measures may be modified to better address pediatric end-of-life care. Second, we suggest the formation of a pediatric quality measure end-of-life task force. These are the next steps to evolving end-of-life quality measures to better fit the needs of seriously ill children.

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Defining current gaps in quality measures for cancer immunotherapy: consensus report from the Society for Immunotherapy of Cancer (SITC) 2019 Quality Summit

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000112 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000112 ◽

Cited By ~ 1

Author(s):

Sara Pai ◽

David Blaisdell ◽

Rachel Brodie ◽

Robert Carlson ◽

Heidi Finnes ◽

...

Keyword(s):

Cancer Immunotherapy ◽

Cancer Care ◽

Expert Panel ◽

Care Delivery ◽

Quality Measures ◽

Quality Measure ◽

Long Term Outcome ◽

Quality Cancer Care ◽

National Quality ◽

Immunotherapy Of Cancer

BackgroundQuality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges.MethodsThus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to,first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to,second, advance priority concepts surrounding quality measures that could be developed and broadly adopted by the field.ResultsAfter reviewing the existing quality measure landscape employed for immunotherapeutic-based cancer care, the expert panel identified four relevant National Quality Strategy domains (patient safety, person and family-centered care, care coordination and communication, appropriate treatment selection) with significant gaps in immunotherapy-based quality cancer care delivery. Furthermore, these domains offer opportunities for the development of quality measures as they relate to cancer immunotherapy. These four quality measure concepts are presented in this consensus statement.ConclusionsThis work represents a first step toward defining and standardizing quality delivery of cancer immunotherapy in order to realize its optimal application and benefit for patients.

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NCI Community Cancer Center Program (NCCCP): Disparities in time between cancer diagnosis and treatment initiation.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.279 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 279-279

Author(s):

Stephanie Teixeira-Poit ◽

Pamela Spain ◽

Michael T. Halpern ◽

Kathleen M. Castro ◽

Irene Prabhu Das ◽

...

Keyword(s):

Breast Cancer ◽

Time Window ◽

Private Insurance ◽

Quality Measures ◽

Diagnosis And Treatment ◽

Cancer Center ◽

Uninsured Patients ◽

Time To Treatment ◽

Hospital Size ◽

National Quality

279 Background: The National Cancer Institute Community Cancer Centers Program (NCCCP) was designed to improve care and reduce cancer disparities at community hospitals. This study examined the number of days between diagnosis and treatment for five National Quality Forum-endorsed cancer quality measures. Methods: A retrospective analysis of data from patients diagnosed and receiving breast or colon cancer treatment at 12 NCCCP sites was performed. We examined time to treatment for cancer quality measures, stratified by concordant and non-concordant patients. We compared patients diagnosed before (2006 – 2007) vs. during (2008-2013) the NCCCP period. Results: Concordant Cases. Time to treatment was significantly greater in the NCCCP vs. pre-NCCCP periods for three measures. Compared to pre-the NCCCP period, time to treatment in the NCCCP period was longer by 26 days for women with breast cancer receiving hormonal therapy (HT). Time to HT increased significantly among most patient and hospital subgroups (race, age, insurance, hospital size). Black, Medicaid, and/or uninsured patients generally had longer-than-average time to treatment for all measures when receiving guideline-concordant care. Non-Concordant Cases. Among women with breast cancer who received treatment outside the measure window, most eligible for multi-agent chemotherapy received treatment within one month after the cut-off. In contrast, a majority eligible for other cancer quality measures received treatment more than one after the cut-off. Among women who were non-concordant for HT, those with Medicare or private insurance were significantly more likely to begin HT within one month after the cut-off than were those with Medicaid. Conclusions: More than half of patients non-concordant on cancer quality measures received treatment more than one month after the treatment window. However, many were non-concordant because they were just outside the time window to be considered concordant (< 30 days), particularly Medicaid patients. Rapid reporting of quality indicators could inform targeted efforts to improve care coordination and concordance rates, particularly among certain patient subgroups.

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Performance on cancer quality measures: Ethnicity, insurance, and census division disparities.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.34 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 34-34

Author(s):

Amanda Browner ◽

Bryan E. Palis ◽

E. Greer Gay ◽

Katherine Mallin ◽

Ryan M. McCabe ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

High Performance ◽

Breast Conservation ◽

Quality Measures ◽

Colon Resection ◽

Breast Conservation Surgery ◽

Delivery Of Care ◽

Census Division ◽

South Central ◽

National Quality

34 Background: Since enactment of Healthy People 2000 (ODPHP.gov, nd), a focus has been to reduce disparity by achieving health equity across all people. We examined disparity for five cancer quality measures with high performance rates (PRs) ( > 85%). Methods: Five measures developed by the Commission on Cancer and endorsed by the National Quality Forum were evaluated for potential ethnicity, insurance, and Census Division disparities. Data from the National Cancer Database were used to examine hospital-level PRs on adjuvant chemotherapy for ER neg breast ca (MAC), hormone therapy for ER+ breast ca (HT), resection of at least 12 nodes in a colon resection (12RLN), and adjuvant chemotherapy for stage III colon ca (ACT) measures for patients diagnosed in 2015. Patients receiving radiation after breast conservation surgery (BCSRT) were diagnosed in 2014 to ensure complete treatment follow-up. Results: Significant disparities exist for all measures on ethnicity between non-Hispanic whites and Hispanics. The least variation of ethnicity occurred within 12RLN (non-significant). Variability within insurance was found most frequently with HT and BCSRT measures, not insured/Medicaid versus Medicare, and not insured/Medicaid versus Private respectively. Location disparity exists for all measures, with South Central states’ significantly lower PRs. Further investigation should focus on access, insurability, and delivery of care to better understand and eliminate disparities. Conclusions: Cancer quality measures, which show high performance nationally, show significant performance variability reflective of on-going disparities of care. [Table: see text]

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New perinatal quality measures from the National Quality Forum, the Joint Commission and the Leapfrog Group

Current Opinion in Obstetrics & Gynecology ◽

10.1097/gco.0b013e328332d1b0 ◽

2009 ◽

Vol 21 (6) ◽

pp. 532-540 ◽

Cited By ~ 35

Author(s):

Elliott K Main

Keyword(s):

Quality Measures ◽

Joint Commission ◽

National Quality Forum ◽

National Quality ◽

Leapfrog Group ◽

The Joint Commission

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Quality Measures in Foot and Ankle Care

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000414 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0004

Author(s):

Grace Xiong ◽

Loretta Chou ◽

Chase Bennett ◽

Robin Kamal

Keyword(s):

Systematic Review ◽

Clinical Care ◽

Healthcare Delivery ◽

Quality Measures ◽

Measure Development ◽

Foot And Ankle ◽

Foot Care ◽

Quality Reporting ◽

National Quality ◽

Clinical Disorders

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Diabetes, Hindfoot, Trauma Introduction/Purpose: National healthcare delivery systems are shifting to value-based models. Understanding quality measures used to assess performance is important as they may be operationalized in alternative payment models, such as bundled payment programs, or quality reporting programs, such as the Merit-Based Incentive Payment System. Previous literature has shown that quality measures in other orthopaedic subspecialties disproportionately focus on effective clinical care or processes of care, while ignoring patient outcomes. We completed a systematic review of quality measures and candidate quality measures that address foot and ankle care to identify gaps in current measures and to inform future measure development initiatives. Methods: We conducted a systematic review of the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures related to foot and ankle care. We also reviewed candidate quality measures from clinical practice guidelines (CPG) in the literature meeting Institute of Medicine CPG criteria. Measures were classified by clinical entity, Donabedian domain (structure, process, or outcome), and the National Quality Strategy (NQS) priority that they addressed. Results: We identified 12 quality measures and 16 candidate measures. Quality measures addressed NQS priorities of “Effective Clinical Care” (33%), “Communication and Coordination of Care” (58%), “Patient Safety” (25%), “Community and Population Health” (8%), and “Person and Caregiver Centered Experience and Outcomes” (8%). All candidate measures addressed “Effective Clinical Care”. Furthermore, 83% of quality measures and 94% of candidates were process measures, 17% of quality and 6% of candidate were outcome measures, and there were no structure measures. Diabetic foot care was the most commonly addressed clinical entity for both quality measures (58%) and candidate measures (69%). Conclusion: Foot and ankle quality measures and candidate measures disproportionately assess effective clinical care and processes of healthcare delivery. Additionally, few clinical disorders within the field are included, focusing primarily on diabetic foot care. Currently only two outcome measures exist, leaving an opportunity for outcome measure development. These patterns are reflected in candidate measures, suggesting that the narrow focus of quality measures will continue unless efforts are made to develop more comprehensive measures. Additional measures that address a broader array of clinical disorders across the spectrum of NQS priorities and Donabedian domains are needed to prepare for a quality-based healthcare system.

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