comprehensive array of psychosocial health services in general and for patients with cancer in particular also are not very visible in major national performance measurement initiatives (see Table 6-4).

Table 6-4 reveals that psychosocial health services are not typically addressed in the limited number of measures of the quality of cancer care. Although components of the model for delivering psychosocial health care described in Chapter 4 (e.g., effective patient–provider communication) and specific psychosocial health services (e.g., treatment for depression) are addressed for health care overall, a well-thought-out, efficient, and strategic set of performance measures addressing psychosocial health care in general or for patients with cancer in particular is not evident. For example, there is no performance measure of the extent to which patients with cancer (or those with other chronic illnesses) have undergone screening or assessment to identify psychosocial problems. Neither are there measures of the extent to which these patients have been linked to needed services.

Measurement of the quality of care does not take place only in the context of performance measurement initiatives; programs that accredit certain types of health care providers are another venue for ensuring that organizations have in place the structures and processes necessary to deliver good-quality health care. The American College of Surgeons’ multidisciplinary Commission on Cancer, for example, sets standards for cancer care delivered primarily in hospital settings, surveys hospitals to assess compliance with those standards, and uses the resulting data to evaluate hospital performance and develop effective educational interventions to improve cancer care at the national and local levels (American College of Surgeons, 2007). However, no organization targets the accreditation of organizations providing ambulatory cancer care. This is problematic as most patients with cancer receive treatment on an ambulatory rather than an inpatient basis.

Performance measurement is well recognized as essential to performance improvement. Measuring specific aspects of the quality of care and reporting the results back to providers is linked both conceptually and empirically to reductions in variations in care and increases in the delivery of effective care (Berwick et al., 2003; Jha et al., 2003). A number of organizations could help develop and test measures of psychosocial health care (e.g., the National Quality Forum, the AHRQ CAHPS team), but the existence of measures alone will not be sufficient to achieve change. Structures and processes to enable use of the measures and leadership with influence over how cancer care is delivered are needed to spearhead the development and use of such measures.

Means of Ensuring the Use of Performance Measures

Effective performance measurement requires mechanisms for conceptualizing the measures, translating these concepts into technical specifications,



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