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Measuring the quality of care for the cancer patient

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Abstract

In recent years, the efforts to better define quality of patient care have focused on attempts to improve on the measurement of quality. These efforts raise three questions: (1) Why attempt to measure quality? (2) What is the best way to measure quality of care of the cancer patient? and (3) What must be done to achieve this? Three main reasons for measuring quality of patient care are to describe the current state, plan strategies for improvement, and implement and monitor improvements. To measure quality, both the definition of quality and the tools available for measurement must be addressed. The difficulty in developing a measurable definition of quality is achieving agreement on the measurable components of quality. The tools to measure quality have evolved to focus on monitoring of key indicators for comparative use. The utility of indicators lies in demonstrating that they have the capacity to identify opportunities for improving care. The Joint Commission is improving measurement tools through the development and testing of oncology indicators for reliability and the capacity to identify opportunities for improving care. The development and teaching of new quality improvement methods to health care professionals also is necessary.

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... One of the most fundamental requirements to the provision of quality cancer care is to ensure that patients receive timely and appropriate treatment following their diagnosis [1]. The Institute of Medicine's National Cancer Policy Board in the United States have concluded in their " Ensuring the Quality of Cancer Care " report that a substantial number of cancer patients were receiving suboptimal treatment and recommended establishment of benchmarks for quality improve- ments [1]. ...
... One of the most fundamental requirements to the provision of quality cancer care is to ensure that patients receive timely and appropriate treatment following their diagnosis [1]. The Institute of Medicine's National Cancer Policy Board in the United States have concluded in their " Ensuring the Quality of Cancer Care " report that a substantial number of cancer patients were receiving suboptimal treatment and recommended establishment of benchmarks for quality improve- ments [1]. In addition, the EUROCARE-4 study postulated that some of the survival differences seen in certain tumour groups between the European countries may be related to the variation in the utilisation of treatments such as adjuvant chemotherapy in node-positive breast cancer, as well as the variable application of evidence-based guidelines [2]. ...
... Optimal chemotherapy utilisation rate (%) Actual chemotherapy utilisation rate (%) Any time First course treatment United States NCDB [1,891011 13] United Kingdom NYCRIS [16] Sweden [12] Oesophagus ...
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Aims. The proportion of patients with upper gastrointestinal cancers that received chemotherapy varies widely in Australia and internationally, indicating a need for a benchmark rate of chemotherapy utilisation. We developed evidence-based models for upper gastrointestinal cancers to estimate the optimal chemotherapy utilisation rates that can serve as useful benchmarks for measuring and improving the quality of care. Materials and Methods. Optimal chemotherapy utilisation models for cancers of the oesophagus, stomach, pancreas, gallbladder, and primary liver were constructed using indications for chemotherapy identified from evidence-based guidelines. Results. Based on the best available evidence, the optimal proportion of upper gastrointestinal cancers that should receive chemotherapy at least once during the course of the patients' illness was estimated to be 79% for oesophageal cancer, 83% for gastric cancer, 35% for pancreatic cancer, 80% for gallbladder cancer, and 27% for primary liver cancer. Conclusions. The reported chemotherapy utilisation rates for upper gastrointestinal cancers (with the exception of primary liver cancer) appear to be substantially lower than the estimated optimal rates suggesting that chemotherapy may be underutilised. Further studies to elucidate the reasons for the potential underutilisation of chemotherapy in upper gastrointestinal tumours are required to bridge the gap between the ideal and actual practice identified.
... One of the most fundamental requirements to the provision of quality cancer care is to ensure that patients receive timely and appropriate treatment following their diagnosis [1]. The Institute of Medicine's National Cancer Policy Board in the United States have concluded in their " Ensuring the Quality of Cancer Care " report that a substantial number of cancer patients were receiving suboptimal treatment and recommended establishment of benchmarks for quality improve- ments [1]. ...
... One of the most fundamental requirements to the provision of quality cancer care is to ensure that patients receive timely and appropriate treatment following their diagnosis [1]. The Institute of Medicine's National Cancer Policy Board in the United States have concluded in their " Ensuring the Quality of Cancer Care " report that a substantial number of cancer patients were receiving suboptimal treatment and recommended establishment of benchmarks for quality improve- ments [1]. In addition, the EUROCARE-4 study postulated that some of the survival differences seen in certain tumour groups between the European countries may be related to the variation in the utilisation of treatments such as adjuvant chemotherapy in node-positive breast cancer, as well as the variable application of evidence-based guidelines [2]. ...
... Optimal chemotherapy utilisation rate (%) Actual chemotherapy utilisation rate (%) Any time First course treatment United States NCDB [1,891011 13] United Kingdom NYCRIS [16] Sweden [12] Oesophagus ...
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The proportion of breast cancer patients that received chemotherapy varies widely in high-income countries. An evidence-based estimate of the optimal chemotherapy utilisation rate for a breast cancer population may serve as a useful benchmark for measuring and improving the quality of care. An optimal chemotherapy utilisation model was constructed using indications for chemotherapy identified from evidence-based guidelines. Data on the proportion of patient (age, performance status and preference) and tumour (stage, size, grade, nodal status, hormone receptor and HER2 status) attributes were obtained and merged with the treatment indications to calculate an optimal utilisation rate. This model was peer-reviewed by a panel of independent experts. Chemotherapy was indicated in 17 of the 24 possible clinical scenarios depicted in the optimal utilisation model. The estimated optimal proportion of breast cancer patients who should received chemotherapy at least once was 68%. Sensitivity analyses showed that the range of optimal rate was 60-69%. The optimal rate appears to be substantially higher than the reported actual rates (29-49%). It is possible to generate an optimal chemotherapy utilisation rate in breast cancer to serve as an evidence-based benchmark. The optimal chemotherapy utilisation rate in breast cancer has remained largely unchanged over the past 15years. The reported actual utilisation rates of chemotherapy in breast cancer populations appear to have remained below the estimated optimal rate, suggesting that potential opportunities for improvement in the compliance to guideline recommended care exist.
... In a report from 1990, the JCAHO had 19 oncology care indicators in the initial development testing. 63 These have been reduced to only nine indicators (listed in the Appendix B). These indicators deal with breast, colon, and lung cancer and focus exclusively on the initial diagnosis and therapy. ...
... In 1999, the Institute of Medicine published Ensuring Quality Cancer Care, which defined elements of quality cancer care, described how quality could be measured, and documented gaps in the quality of care for patients with cancer. 1 The report recommended the creation of a quality monitoring system to report regularly on the quality of care for these patients. The National Initiative on Cancer Care Quality, initiated by ASCO in 2000, was the first systematic investigation of the quality of cancer care in the United States. ...
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