Enhancing Data Systems to Improve the Quality of Cancer Care (2000) / Chapter Skim
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Findings and Recommendations
Findings and Recommendations
Pages 76-94
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From page 76... ...
The board recognized that current data systems and quality assessments were far from this ideal. This chapter summarizes the board's findings and its recommendations for steps that can be taken to enhance current data systems to bring about sustained improvements in cancer care.
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From page 77... ...
4. National, population-based case selection complete ascertainment of incident cancer cases by cancer registries is a prerequisite for national quality assessments, allowing case selection for studies whose results can be generalized to the total population, as well as assessments of quality for important subgroups, for example, individuals of low socioeconomic status, and individuals enrolled in certain types of health plans or delivery systems.
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From page 78... ...
Some programs depend entirely on retrospective reviews of medical charts or hospital cancer registry data, while others rely on multiple sources, for example, administrative claims data linked to cancer registry data. Chapter 3 in this report presents 10 case studies to illustrate how various health systems small physician practices, large integrated delivery systems, professional associations, purchasing coalitions, and states have used available data to assess cancer care quality (Table 6.1~.
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From page 79... ...
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From page 80... ...
There do not appear to be many quality improvement programs addressing cancer care, perhaps because of the noted limitations above. On the other hand, innovations within some of the emerging cancer disease management programs and physician practice management companies are noteworthy.
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From page 81... ...
The development of guidelines through the National Comprehensive Cancer Network (NCCN) seems to have spurred quality monitoring activities beyond the cancer centers that developed them, suggesting that if a core set of cancer care measures were available, it would be adopted by systems of care for quality improvement programs.
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From page 82... ...
Three well-established data sources for assessing care on a national level are available: the National Program of Cancer Registries (NPCR) , the Surveillance, Epidemiology and End Results Program (SEER)
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From page 83... ...
Broad consensus has been reached about how to assess some aspects of quality of care for many common cancers, but specific measures are still being developed and tested within health delivery systems. Quality improvement initiatives for cancer care have been impeded both by the absence of thoroughly tested quality measures and limitations of available data systems.
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From page 84... ...
monitor the progress of ongoing efforts to improve standard reporting of cancer stage and comorbidity. Achieving consensus on a core set of cancer care quality measures may prove to be difficult; however, a number of resources are (or soon will be)
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From page 85... ...
, HCFA's Ambulatory Care Quality Improvement Project) and consequently was able to release a fully tested core quality indicator set in 1998, within 1 year of the project's onset (B.
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From page 86... ...
The QuIC's goal is to ensure that all federal agencies involved in purchasing, providing, studying, or regulating healthcare services are working in a coordinated way toward the common goal of improving quality of care. The complementary Quality Forum established with a private-sector base will focus on measurement issues in an effort to ensure system-wide capacity to evaluate and report on the quality of care and to further consumer understanding and use of quality measures.
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From page 87... ...
The databases themselves lack the detailed treatment and comorbidity information needed for most quality-of-care studies. Through special studies, representative samples of patients can be identified through registries and followed up to collect the more detailed standardized comorbidity and treatment data (e.g., by contacting attending physicians by mail or by abstracting records in oncologists' offices)
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From page 88... ...
NPCR's primary purpose is cancer surveillance, but NPCR, together with SEER, has great potential to facilitate national, population-based assessments of the quality of cancer care through linkage studies and by serving as a sample frame for special studies. ACoS-CoC and the American Cancer Society (ACS)
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From page 89... ...
Facilities approved by ACoS-CoC have cancer registrars forward to NCDB the same data reported to the state cancer registry along with some additional diagnostic and treatment-related data. NCDB faces the same problem as state cancer registries of limited access to information on subsequent care occurring outside of the reporting facility.
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From page 90... ...
Analytic Capacity Cancer care data, even when enhanced, are of little use if only a few individuals are trained in their analysis and interpretation. Many methodologic issues need to be resolved in establishing quality improvement systems (e.g., setting benchmarks, creating report card formats for providers and consumers, adjusting for case-mix differences)
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From page 91... ...
As conceived, this research program will evaluate whether observed patterns of care are associated with good outcomes, establish the use of a core set of outcome measures in research and medical care applications, investigate methodologic innovations to improve data collection, and, using the above, promote the development of a national cancer data system to monitor the quality of cancer care (NCI, l999b)
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From page 92... ...
The board recommends that PROs across the country use the Colorado linkage study as a model as they plan their quality improvement initiatives. Many cancer registries are achieving near complete levels of case ascertainment, making them valuable as sampling frames for targeted special studies.
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From page 93... ...
Resources should also be made available through the NPCR and SEER programs to provide technical assistance to states to help them expand the capability of using cancer registry data for quality improvement initiatives. NPCR should also be supported in its efforts to consolidate state data and link them to national data files.
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From page 94... ...
Findings from the demonstrations should be disseminated widely to consumers, payers, purchasers, and cancer care providers. In summary, the broad availability of cancer-specific data resources makes cancer a unique disease for targeting quality improvement initiatives in patient care.
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