By Christina Frangou
Cancer centers that participated in a performance tracking system significantly improved their adherence to key quality measures in oncologic care, according to a new study. Developed by the Commission on Cancer of the American College of Surgeons (ACS), the system also helps hospitals to track their patients’ information, which prevents medical records from getting lost, the researchers said.
“Cancer care is unique in that it requires extensive coordination with providers across disciplines to ensure patients receive all of their treatments. Patients are not only getting surgical treatment but also chemotherapy, radiation and possibly hormone therapy,” said Erica McNamara, MPH, lead study author and quality improvement analyst at the ACS. “Our system is built to provide an extra layer of support in the coordination of that care.”
Ms. McNamara presented the findings at the American Society of Clinical Oncology’s inaugural Quality Care Symposium in December (abstract 286).
The ACS’ Rapid Quality Reporting System (RQRS) provides feedback to cancer centers on individual patient care while the patient is still undergoing oncologic treatment.
Accredited cancer centers submit data about their current breast or colorectal cancer cases on a monthly or quarterly basis. The RQRS system tracks the data for adherence to five quality measures for breast and colon cancer that are endorsed by the National Quality Forum, a not-for-profit organization whose mission is to “improve the quality of American health care.”
These measures, which are considered the standard of care, include radiation therapy following breast-conserving surgery; multiadjuvant chemotherapy for hormone receptor–negative breast cancer patients; hormone therapy for hormone receptor–positive breast cancer patients; adjuvant therapy for lymph node–positive colon cancer patients; and the removal and pathologic examination of at least 12 regional lymph nodes for resected cancer.
The RQRS system will send an alert to the cancer center when patients are scheduled to enter the next stage of treatment. Physicians, cancer registrars and cancer program administrators have access to the feedback. For example, a hospital will receive a color-coded alert to indicate that staff should check on a patient’s treatment status when the RQRS does not receive a timely report confirming that a treatment decision or adjuvant therapy has been completed.
Furthermore, the RQRS system provides performance rates and comparisons to other centers, based on current patients and clinical practice.
Study researchers examined data from 64,129 breast and colorectal cancer patients treated between 2006 and 2010 at 64 RQRS-participating cancer programs nationally. The investigators assessed how well the cancer programs adhered to the five quality measures before and after participation in the program.
Analysis of the data showed that all five compliance rates rose considerably after hospitals joined RQRS. The greatest increase was in the number of patients who received hormone therapy for breast cancer, which grew from 47% in 2006 to 85% to 2010. Delivery of adjuvant chemotherapy for colon cancer increased 18%, from 68% to 86%, and the percentage of patients from whom 12 or more lymph nodes were retrieved rose from 70% to 90%.
“This study is really noteworthy in that the development of this database significantly improved cancer care within a very short period of time,” said Jyoti Patel, MD, a thoracic oncologist and associate professor of medicine, Feinberg School of Medicine of Northwestern University, Chicago. “This sort of innovative feedback can provide real-time improvement in care, so it’s very exciting.”
Investigators also reported that performance rates differed by patient age, race and payer status (private insurance versus Medicare), but the relative number and size of the disparities were reduced in participating programs two years after implementing the RQRS system.
“The results from this analysis suggest that those differences may actually have been more of a reflection of incomplete data and information in the registries than a reflection of differences in care delivery to subpopulations of patients,” said Andrew Stewart, MA, study coauthor and National Cancer Database senior manager at the ACS.
These measures have been the focus of significant public awareness campaigns, led by professional organizations and the National Quality Forum, and they frequently are discussed at surgical and oncologic meetings.
Officials familiar with RQRS said that the system boosts compliance with quality measures because it improves the coordination of evidence-based care among different disciplines, and it requires more complete reporting of adjuvant therapy data.
Participants in the program said that they regularly “catch” patients who otherwise would have been missed, when the system issues an alert that the patient should have received adjuvant therapy.
“We find that after about six to nine months of using RQRS, one-third of program participants report that they have prevented RQRS patients from slipping through the cracks or not receiving timely adjuvant care,” Ms. McNamara said.
An anonymous RQRS participant said, “We have prevented at least two patients from slipping through the cracks. The oncology providers now ask for the reports to be given to them monthly so that they can review the yellow and orange alert cases and prevent any red alerts.”
The RQRS system is the only known disease-specific treatment monitoring system in the country. The program was launched nationally in September 2011, in 66 test sites that are accredited by the Commission on Cancer. Currently, there are about 400 centers using the system.
The researchers are developing additional clinical measures to expand the use of RQRS to encompass adherence to quality measures for lung, stomach and esophagus cancers.