The Outcomes of Cancer Outcomes Research: focusing on the National Cancer Institute's quality-of-care initiative.
ABSTRACT To assess the impact of outcomes research, the Agency for Healthcare Policy and Research has proposed a four-level typology that successively distinguishes between research that (1) adds to the knowledge base only, (2) affects practice policies, (3) influences the delivery of care, and (4) leads to changes in health outcomes. The agency has concluded that outcomes research to date has made substantial contributions at level 1, but has had little impact at levels 2 to 4.
To describe the National Cancer Institute's emerging agenda in cancer outcomes research, focusing on how it has been shaped early on to support the institute's quality of care initiative and noting whether each new project represents outcomes research at level 1, 2, 3, or 4.
Cancer outcomes research describes, interprets, and predicts the impact of various influences, especially (but not exclusively) interventions on endpoints that matter to decision makers. The institute's projects to improve the scientific quality of final endpoint measures, strengthen the methodologic and empirical basis for quality of care analysis, and enhance the application of health-related quality-of-life measures in clinical trials represent level 1 applications of outcomes research. Collaborative projects with federal agencies to translate evidence into practice and a new public and private effort to identify core measures of cancer quality represent level 2 and level 3 outcomes research.
The stage has been set for carrying out a balanced portfolio of level 1 to 3 outcomes research projects in cancer, with the ultimate (level 4) aim of improving cancer-related health outcomes.
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ABSTRACT: The purpose of the study was to develop organization-based core performance measures (CPMs) for breast cancer patients treated in hospitals that participated in cancer quality improvement programmes in Taiwan. CPMs were developed in three stages that included a preparation, a consensus building stage, and two stages of stakeholder feedback. Three criteria and seven subcriteria were applied in the development process. Indicators listed in a Delphi questionnaire were based on a literature search, indicators developed by relevant institutions and discussion by authors. Each indicator needed to meet inclusion criteria as a final indicator. Evidence-based guidelines, expert opinions from panel group, 27 hospitals and empirical data were all applied to develop and revise the core measures. Fifteen out of 28 indicators were selected and modified after the three stages. There were two pre-treatment indicators for screening and diagnosis, nine treatment-related indicators, and four monitoring-related indicators. Six indicators were supported by evidence level I, and four indicators by level II evidence. The CPMs for breast cancer can be developed systematically and be applied for internal quality improvement and external surveillance. Our experience can be extended to other cancer sites and adapted to link with pay for performance or certification program in cancer care.European Journal of Cancer Care 12/2007; 17(1):5 - 18. DOI:10.1111/j.1365-2354.2007.00796.x · 1.76 Impact Factor
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ABSTRACT: The study of health outcomes and the reduction in health disparities is at the forefront of the nation's health care agenda. A theme in the disparities literature is the call for a data infrastructure that can track progress toward goals aimed at reducing differences in health outcomes. This article describes a strategy for linking Medicaid, Medicare, and Michigan Tumor Registry data for the purposes of studying disparities in cancer diagnosis, quality of care, and survival. The authors review their procedures for ensuring that a correct match between files occurred and offer guidance for merging and assessing the quality of these complex linked data sets. A cohort of 113,604 subjects (90%) from a population of 125,900 subjects was correctly linked from the Michigan Tumor Registry to Medicare and Medicaid files. Using probabilistic and deterministic methods, the prediction rate of the Medicaid match to the Michigan Tumor Registry was 93%. Approximately 13% of the subjects were dually eligible for Medicare and Medicaid. An expansive data set reflecting the Medicare and Medicaid medical service utilization and outcomes for a cohort of individuals age 65 years and older when diagnosed with cancer was created. This data set serves as a cornerstone of a health outcomes data infrastructure. The methodology described may serve as a model for other researchers seeking to create a similar data set in their state.Medical Decision Making 07/2007; 27(4):352-63. DOI:10.1177/0272989X07302129 · 2.27 Impact Factor
- Journal of Clinical Oncology 09/2004; 22(15):2992-6. DOI:10.1200/JCO.2004.06.020 · 17.88 Impact Factor