Quality of integrated care for patients with nonsmall cell lung cancer (original) (raw)
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Cancer Control, 2014
pathologists, nurses, and other specialists. Given these factors, efforts focusing on enhancing quality patient care are necessary to improve clinical outcomes and reduce the human and financial toll of lung cancer. The development and implementation of qualitybased performance measures have the potential to improve outcomes for patients with cancer. Practicebased education that integrates measures focusing on specific clinical decisions and processes can provide a more personalized approach to improving knowledge when compared with more traditional educational platforms. Through the use of self-assessments, clinicians are provided a realistic view of their practices, which allows for more conscientious efforts to align behavioral and systems-related goals. Quality improvement in oncology has been a growing focus of attention over the last 15 years. The National Cancer Policy Board (NCPB) was established by the Institute of Medicine and the National Research Council in an effort to assess the quality of cancer prevention, control, diagnosis, treatment, and palliation. 3 In an ensuing report, the NCPB concluded that wide disparities exist in the quality of cancer care in the United States, thereby highlighting the need for performance measures to improve clinical outcomes. 4 The American Society of Clinical Oncology (ASCO) responded to this call for quality improvement by de-From the
Facility Characteristics and Quality of Lung Cancer Care in an Integrated Health Care System
Journal of Thoracic Oncology, 2014
Introduction: In a national, integrated health care system, we sought to identify facility-level attributes associated with better quality of lung cancer care. Methods: Adherence to 23 quality indicators across four domains (Diagnosis and Staging, Treatment, Supportive Care, End-of-Life Care) was assessed through abstraction of electronic records from 4804 lung cancer patients diagnosed in 2007 at 131 Veterans Health Administration facilities. Performance was reported as proportions of eligible patients fulfilling adherence criteria. With stratification of patients by stage, generalized estimating equations identified facility-level characteristics associated with performance by domain. Results: Overall performance was high for the older (mean age 67.7 years, SD 9.4 years), predominantly male (98%) veterans. However, no facility did well on every measure, and range of adherence across facilities was large; 9% of facilities were in the highest quartile for one or more domain of care, more than 30% for two, and 65% for three. No facility performed consistently well across all domains. Less than 1% performed in the lowest quartile for all. Few facility-level characteristics were associated with care quality. For End-of-Life Care, diagnosis and treatment within the same facility, availability of cancer psychiatry/psychology consultation services, and availability of both inpatient and outpatient palliative care consultation services were associated with better adherence. Conclusions: Quality of Veterans Health Administration lung cancer care is generally high, though substantial variation exists across facilities. With the exception of the salutary impact of palliative care consultation services on end-of-life quality of care, observed facility-level characteristics did not consistently predict adherence to indicators, suggesting quality may be determined by complex local factors that are difficult to measure.
Evaluating the quality of cancer care
Cancer, 2000
BACKGROUND. The rise of managed care has increased interest in measuring, reporting, and improving quality of care. To date, quality assessment has relied on a leading indicator approach, which may miss important variations in care. The authors developed cancer specific indicators using a novel case-based approach for a quality measurement tool designed to compare different managed care organizations.
Nationwide Quality Improvement in Lung Cancer Care
Journal of Thoracic Oncology, 2013
Introduction: To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators. Methods: A wide range of indicators was established, validated, and monitored. By registration of all lung cancer patients since the year 2000, data on more than 40,000 patients have been included in the database. Results are reported periodically/quarterly and submitted to formal auditing on an annual basis. Results: Improvements in all outcome indicators are documented and statistically significant. Thus the 1-year overall survival rate has increased between 2003 and 2011 from 36.6% to 42.7%, the 2-year survival rate from 19.8% to 24.3%, and the 5-year survival rate from 9.8% to 12.1%. Five-year survival after surgical resection has increased from 39.5% to 48.1%. Improvements of waiting times, accordance between cTNM and pTNM, and resection rates are documented. Conclusion: The Danish experience shows that a national quality management system including national guidelines, a database with high data quality, frequent reports, audit and commitment from all stakeholders can contribute to improve clinical practice, improve core results, and reduce regional differences.
Cancer Medicine, 2021
Quality measurement has become a priority for national healthcare reform, and valid measures are necessary to discriminate hospital performance and support value‐based healthcare delivery. The Commission on Cancer (CoC) is the largest cancer‐specific accreditor of hospital quality in the United States and has implemented Quality of Care Measures to evaluate cancer care delivery. However, none has been formally tested as a valid metric for assessing hospital performance based on actual patient outcomes.
Journal of oncology practice / American Society of Clinical Oncology, 2014
Audit and feedback have been widely used to enhance the performance of various medical practices. Non-small-cell lung cancer (NSCLC) is one of the most common diseases encountered in medical oncology practice. We investigated the use of audit and feedback to improve the care of NSCLC. Medical records were reviewed for patients with NSCLC first seen by a medical oncologist in 2006 (n = 518) and 2009 (n = 573) at 10 oncology practices participating in the Florida Initiative for Quality Cancer Care. In 2008, feedback from 2006 audit results was provided to practices, which then independently undertook steps to improve their performance. Sixteen quality-of-care indicators (QCIs) were evaluated on both time points and were examined for changes in adherence over time. A statistically significant increase in adherence was observed for five of 16 QCIs. Adherence to brain staging using magnetic resonance imaging or computed tomography scan for stage III NSCLC (57.8% in 2006 v 82.8% in 2009; ...