scholarly journals Measuring Quality of Care in the Treatment of Colorectal Cancer: The Moffitt Quality Practice Initiative

2007 ◽  
Vol 3 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Paul B. Jacobsen ◽  
David Shibata ◽  
Erin M. Siegel ◽  
Mihaela Druta ◽  
Ji-Hyun Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Medical Records ◽  
Initial Phase ◽  
Pathology Report ◽  
Self Assessment ◽  
Specific Level ◽  
Lower Adherence

Purpose The Moffitt Quality Practice Initiative (MQPI) is a practice-based system of quality self-assessment, the ultimate goal of which is to improve the quality of cancer care at a statewide level. The initial phase of this project focused on developing procedures, determining feasibility, and evaluating utility for assessing quality of care for colorectal cancer within an existing affiliate network. Patients and Methods Representatives from four oncology groups selected quality measures consistent with evidence-, consensus-, and safety-based guidelines that could be abstracted from medical records. Trained abstractors then reviewed records of all eligible colorectal patients seen by each practice in 2004. Frequencies of responses for each indicator were tabulated for overall and practice-specific level of adherence and were compared among practices. Results Adherence was uniformly high for several indicators, including confirmatory pathology report, staging information, and chemotherapy discussion or recommendation. Lower adherence was evident across practices for performance of carcinoembryonic tests and complete colonoscopic evaluations. Significant variation among practices was evident only for consent for chemotherapy. Conclusion The initial phase of MQPI demonstrated the feasibility and utility of assessing quality indicators for colorectal cancer among members of an existing affiliate network. Findings identified areas where adherence to care was uniformly high, but also identified areas where both overall and practice-specific adherence were less than optimal. These efforts lay the groundwork for expanding MQPI in several directions that have in common the potential to improve the quality of cancer care on a statewide basis.

Lung cancer quality of care in Uruguay: First experience in a public hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 231-231
Author(s):  
Maria Clara Rodriguez Palleiro ◽  
Virginia Rodriguez ◽  
Viviana Dominguez ◽  
Siul Salisbury ◽  
Alonzo Rodriguez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Medical Records ◽  
Adherence Rate ◽  
Pathology Report ◽  
Histologic Subtype ◽  
Starting Point ◽  
The Impact

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.

A Process for Measuring the Quality of Cancer Care: The Quality Oncology Practice Initiative

2005 ◽  
Vol 23 (25) ◽  
pp. 6233-6239 ◽  
Author(s):  
Michael N. Neuss ◽  
Christopher E. Desch ◽  
Kristen K. McNiff ◽  
Peter D. Eisenberg ◽  
Dean H. Gesme ◽  
...  
Keyword(s):  
Cancer Care ◽  
Quality Care ◽  
Pathology Report ◽  
Self Assessment ◽  
Colon And Rectal Cancer ◽  
High Concordance ◽  
American Society ◽  
Oncology Practice ◽  
Self Examination

Purpose The Quality Oncology Practice Initiative (QOPI) is a practice-based system of quality self-assessment sponsored by the participants and the American Society of Clinical Oncology (ASCO). The process of quality evaluation, development of the pilot questionnaire, and preliminary results are reported. Methods Physicians from seven oncology groups developed medical record abstraction measures based on practice guidelines and consensus-supported indicators of quality care. Each practice completed two rounds of records review and received practice and aggregate results. Mean frequencies of responses for each indicator were compared among practices. Results Participants universally, if informally, find QOPI helpful, and results show statistically significant variation among practices for several indicators, including assessing pain in patients close to death, documentation of informed consent for chemotherapy, and concordance with granulocytic and erythroid growth factor administration guidelines. Measures with universally high concordance include the use of serotonin antagonist antiemetics according to the ASCO guideline; the presence of a pathology report in the record; the use of chemotherapy flow sheets; and adherence to standard chemotherapy recommendations for patients with certain stages of breast, colon, and rectal cancer. Concordance with quality indicators significantly changed between survey rounds for several measures. Conclusion Pilot results indicate that the QOPI process provides a rapid and objective measurement of practice quality that allows comparisons among practices and over time. It also provides a mechanism for measuring concordance with published guidelines. Most importantly, it provides a tool for practice self-examination that can promote excellence in cancer care.

Measuring quality of care in the treatment of colorectal cancer: The Moffitt Network Initiative on Practice Quality (MNIPQ)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6001-6001
Author(s):  
P. B. Jacobsen ◽  
D. Shibata ◽  
E. Siegel ◽  
J. Lee ◽  
M. Druta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Quality Of Care ◽  
Rectal Wall ◽  
Cancer Center ◽  
Pathology Report ◽  
Improve Quality ◽  
P Values ◽  
Colon And Rectal Cancer

6001 Background: As the first step in a larger effort to improve quality of care among its member institutions, the MNIPQ sought to develop and implement methods to assess quality of care in the treatment of colorectal cancer. The current report focuses on our initial experience conducting quality assessments at 4 of 20 member institutions. Methods: Medical chart reviews were conducted of all patients diagnosed with colon or rectal cancer in 2004 and seen by a medical oncologist at the Moffitt Cancer Center or at any of three affiliate institutions. Abstractors, who were trained and periodically monitored, conducted the reviews using a web-based abstraction tool. Abstraction focused on assessing adherence to quality indicators consistent with evidence-, consensus-, and regulatory-based guidelines. Variability in adherence across sites was evaluated by conducting Fisher’s exact tests. The 186 patients whose charts were reviewed were predominantly female (57%) and diagnosed with colon cancer (74%). Results: Adherence was consistently (p values>.05) high across all four study sites for: presence of a pathology report confirming malignancy (91–100%); evidence of staging based on established criteria (88–94%); documentation of discussion or referral for chemotherapy in cases of lymph node (colon and rectal cancer) or rectal wall (rectal cancer) involvement (89–100%); and presence of chemotherapy flow sheets (92–100%). Adherence was consistently (p values>.05) lower across sites for: performance of complete colon evaluation within 12 months of surgery (24–47%) and performance of CEA test before (48–74%) or in the 6 months after (56–82%) surgery or chemotherapy. Adherence varied significantly (p < .001) across sites only for documentation of consent for patients treated with chemotherapy (41–100%). Discussion: Findings identified several areas where efforts should be made to improve the quality of colorectal cancer care at one or more member institutions. In addition, the methods developed have laid the groundwork for future efforts to measure and improve quality of care for other cancers and among a larger number of member institutions. No significant financial relationships to disclose.

scholarly journals Concordance of Patient and Caregiver Reports on the Quality of Colorectal Cancer Care

2019 ◽  
Vol 15 (11) ◽  
pp. e979-e988
Author(s):  
Rachel D. Havyer ◽  
Michelle van Ryn ◽  
Patrick M. Wilson ◽  
Lauren R. Bangerter ◽  
Joan M. Griffin
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Secondary Analysis ◽  
Care Quality ◽  
Patient Reports ◽  
Quality Ratings ◽  
Caregiver Quality ◽  
Very High

PURPOSE: We aimed to better understand how similarly patients with colorectal cancer and caregivers view care quality and to assess factors that may influence concordance. MATERIALS AND METHODS: We conducted a secondary analysis of paired patient and caregiver quality ratings of colorectal cancer care in three specific domains: surgery, chemotherapy overall, and chemotherapy nursing. Agreement was assessed with difference scores, concordance with Gwet second-order agreement statistics (AC2), and variation in agreement with stratified analyses. We examined whether the care experiences of patients and caregivers were associated with top-box (most-positive) ratings and examined variations in concordance on the basis of the presence of a top-box score. RESULTS: Four hundred seventeen patient-caregiver dyads completed the surveys. Quality-of-care ratings were positively skewed, with most dyads indicating top-box ratings. Patient and caregiver care experiences were highly associated with top-box ratings. Overall patient-caregiver concordance was very high for all three care domains (surgery: AC2, 0.87 [95% CI, 0.83 to 0.90]; chemotherapy overall: AC2, 0.84 [95% CI, 0.79 to 0.88]; chemotherapy nursing: AC2, 0.91 [95% CI, 0.87 to 0.94]). Stratified analyses of patient and caregiver characteristics did not identify any patterns that consistently affected concordance. The concordance statistic significantly decreased for all three outcomes ( P < .001), however, when the patient or caregiver assessed quality as anything other than top box. CONCLUSION: Caregiver and patient reports on care quality were highly concordant for top-box care and did not vary with patient or caregiver factors. Additional exploration is needed to identify reasons for increased variability when the quality scores were less than a top-box response.

Concordance between patient and family caregiver reports of quality of colorectal cancer care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 187-187
Author(s):  
Rachel D. Havyer ◽  
Michelle van Ryn ◽  
Patrick Wilson ◽  
Joan M. Griffin
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Family Caregiver ◽  
Cancer Care ◽  
Patient Reports ◽  
Lower Stage ◽  
Care Assessment ◽  
Significant Difference ◽  
Patient Reported

187 Background: Patient-reported evaluations of interpersonal quality of care are essential elements of quality of cancer care assessment. At times, patients may be unable to report themselves on their care experience and systems may rely on proxy reports. The validity of this approach is dependent on the degree to which family caregiver assessments are concordant with patient assessments. Methods: A VA cohort of colorectal cancer (CRC) patients and their caregivers both completed a self-administered questionnaire on the quality of VA cancer care in 3 specific domains: surgery, chemotherapy overall and chemotherapy nursing care, all measured on a 5-point Likert scale. Because the kappa statistic penalizes skewed distributions which are commonly seen in patient satisfaction reports, agreement between patients and caregivers on perceptions of quality care were measured using Gwet’s AC2 statistic. Stratified analyses on caregiver burden, race, education, and age as well as patient’s stage of disease were used to assess variation in agreement. Results: 417 caregiver-patient dyads completed the survey (70% response rate), of whom 362 (86.8%) had surgery and 195 (46.8%) had chemotherapy. Overall agreement was high for the 3 quality of care domains: AC2 (95% CI): 0.870 (0.838, 0.903) for surgery, 0.835 (0.786, 0.884) for chemotherapy overall and 0.906 (0.868, 0.944) for chemotherapy nurses. Stratified analyses of agreement showed particular populations of higher or lower agreement; however the findings were inconsistent across the three domains and most were not statistically significant. Patients with lower stage (I-II) had higher agreement than higher stages (III-IV) (AC2: 0.967 and 0.879 respectively, P = 0.006) but only in the chemotherapy nurses domain. For the surgery domain, age was the only significant difference in agreement (0.816, 0.912, and 0.838 for < 50, 51-65, and > 65 respectively, P = 0.03). Conclusions: Family caregiver reports on the quality of CRC care were highly concordant with patient reports. Therefore, family caregivers may be able to provide reasonable proxy report on measures of quality of cancer care when patient reports are unavailable.

scholarly journals Florida Initiative for Quality Cancer Care: Improvements on Colorectal Cancer Quality of Care Indicators during a 3-Year Interval

2014 ◽  
Vol 218 (1) ◽  
pp. 16-25.e4 ◽  
Author(s):  
Erin M. Siegel ◽  
Paul B. Jacobsen ◽  
Ji-Hyun Lee ◽  
Mokenge Malafa ◽  
William Fulp ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Quality Cancer Care

scholarly journals Evaluating the Quality of Colorectal Cancer Care in the State of Florida: Results From the Florida Initiative for Quality Cancer Care

2012 ◽  
Vol 8 (4) ◽  
pp. 239-245 ◽  
Author(s):  
Erin M. Siegel ◽  
Paul B. Jacobsen ◽  
Mokenge Malafa ◽  
William Fulp ◽  
Michelle Fletcher ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
The State ◽  
Quality Cancer Care ◽  
Systemic Level ◽  
Care Practices

Although the quality of care delivered within the Florida Initiative for Quality Cancer Care practices seems to be high, several components of care were identified that warrant further scrutiny on a systemic level and at individual centers.

Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States?

2006 ◽  
Vol 24 (4) ◽  
pp. 626-634 ◽  
Author(s):  
Jennifer L. Malin ◽  
Eric C. Schneider ◽  
Arnold M. Epstein ◽  
John Adams ◽  
Ezekiel J. Emanuel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
United States ◽  
Cancer Care ◽  
Medical Records ◽  
Significant Variation ◽  
Quality Measures ◽  
The United States ◽  
Recommended Care

Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures. Results Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs. Conclusion Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.

scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

scholarly journals Multidisciplinary Cancer Care With a Patient and Physician Satisfaction Focus

2010 ◽  
Vol 6 (6) ◽  
pp. e35-e37 ◽  
Author(s):  
Gregory Litton ◽  
Dianne Kane ◽  
Gina Clay ◽  
Patricia Kruger ◽  
Thomas Belnap ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Care ◽  
Physician Satisfaction ◽  
Care Process ◽  
Multidisciplinary Clinic ◽  
Intermountain Healthcare ◽  
Multidisciplinary Clinics

If implemented appropriately, multidisciplinary clinics can enhance quality of care and increase downstream revenue. The multidisciplinary clinic at Intermountain Healthcare has greatly improved the cancer care process for patients, physicians, and the community.

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