Recorded presentation

Philip Renner, MBA¹, Joachim Roski, PhD, MPH², L. Gregory Pawlson, MD, MPH, FACP², and Angeline Carlson, PhD³. (1) Measures Development, National Committee for Quality Assurance (NCQA), 2000 L St., N.W., Suite 500, Washington, DC 20036, (202) 955-1592, renner@ncqa.org, (2) Quality Measurement, NCQA, 2000 L. Street, NW, Suite 500, Washington, DC 20036, (3) Data Intelligence, P.O. Box 44993, Eden Prairie, MN 55344

Objective Over the last decade there has been growing interest among a variety of stakeholders in assessing the outcomes or results of medical care. Treatment of patients with cancer has been challenged by the same influences that have stimulated this same broad interest. Among these are the awareness of practice variation; the increased recognition of the patient’s role in decision making; acknowledgement that treatment decisions in oncology must be balanced against the desire to prolong life and the need for a decent quality of life in that process; growing pressure for cost containment; and concern among the public, providers and policymakers that efforts to control spending may result in decreases in quality of care.

Design A two-dimensional framework for measuring quality of care in cancer was developed. The first dimension spans the type of care being measured, which includes site-specific technical clinical quality, clinical measures that can be applied across sites, and experience of care measurement. The second dimension consists of levels of the health system against which measures can be applied. Barriers to developing and implementing quality measures analyzed within this framework.

Findings Development of quality measures in cancer care is challenged by a number of factors, including the lack of an accountable delivery system, the heterogeneity of cancer treatment, the fragmentation of cancer care across providers and settings, incomplete or fragmented data sources, and the lack of broadly accepted evidence-based guidelines for cancer treatment.

Conclusions Methodological and logistical problems make quality of care measures in oncology a difficult area for quality measurement. However balancing this difficulty is the high impact and importance of care for cancer patients as an indicator of quality of care, and the opportunity for development of quality measures to facilitate quality improvement. The difficulties suggest an approach that relies on incremental steps, focused 1) on the development of measures in areas where there is some existing consensus, and 2) further research into methods of data collection to improve the relevance, completeness, and timeliness of treatment data.

Implications There is a growing concern among purchasers, payers, regulators, and consumers regarding the lack of standardized quality data in cancer care. Creative solutions will be required to develop and report meaningful, reliable quality measures for the assessment of cancer care delivered to people in the United States.

Learning Objectives:

• Describe critical aspects of quality measures in cancer care
• List barriers to developing quality measures in cancer care
• Describe potential solutions to aid in quality measurement in cancer care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation