The business of oncology measures (or metrics) can be a complicated one, however your organizations refer to them. Building internal cancer quality dashboards is often a confusing process. How do you know which factors you should be measuring, monitoring and sharing? Which information systems can provide real-time data? And what if that data needs to be aggregated from a few different systems to get a complete data set?
Those are all great questions. Here’s another one: where do you start when trying to implement (or improve) your measurements?
First, it’s beneficial to be aware of the most trusted quality tools and accreditation programs available. A partial list would include:
- American College of Surgeons Commission on Cancer (CoC) (National Cancer Database (NCDB) and Cancer Program Practice Profile Reports (CP3R))
- National Accreditation Program for Breast Centers (NAPBC, Breast Only)
- National Quality Measures for Breast Centers (NQMBC, Breast Only)
- National Practice Benchmark (NPB)
- Physician Quality Reporting System (PQRS)
- Quality Oncology Practice Initiative (QOPI)
- National Quality Forum (NQF)
- AONN Standardized Metrics Source Document
- Rapid Quality Reporting System (RQRS)
First, organized breast cancer centers seeking separate certification or accreditation should certainly consider NAPBC and NQMBC. As these organizations focus solely on breast health, their measures and standards are more tailored and better suited to the specific care breast cancer requires. A few of the breast-specific measures overlap with each other across measuring bodies.
Also, many of the measures should be shared between the breast center and the larger cancer center to reduce the redundancy of reporting. This data comes from a compilation of radiology systems, mammography/breast reporting systems, the EHR, practice EMRs, care coordination/navigation systems and the cancer registry. When shared across specialty lines, the data become an important addition to plans for improving the quality of care.
For the cancer center seeking or wishing to maintain CoC accreditation, it is important to pay attention to measures long before survey time. Ensuring that data reporting is an integrated part of processes and not simply something that comes up when needed for accreditation is one of the best ways to ensure that patient care is measured and maintains a certain level of quality. In this case, CP3R measures through the NCDB are a must have, such as NQF #219, which requires radiation therapy to be administered within 365 days of diagnosis for women that are younger than 70 years old and are receiving breast conserving surgery.
At the very least, most hospital-based cancer centers should submit all eligible cases for all valid performance measures within RQRS. RQRS supports reporting and quality improvement by providing real-time data on hospitals’ adherence to cancer care measures. The data covers the spectrum from patient identifiers to treatment notes to EHR records. Ideally, that data is used to improve patient care coordination as well as ensure that being an accredited cancer center is not just a label, but also a philosophy.
However, there are still pronounced "gaps" in most of the measures out there. Many do not include functional status, measures addressing care coordination, management of comorbidities, patient prescription adherence, survivorship, marker-specific therapies and other areas of treatment. And the significant variance (and volume) in cancer diagnoses makes it difficult to set standards defining quality of care across the patient spectrum. Further, the debate over EHR interoperability means that sometimes sharing data across systems remains far too difficult.
Even with the gaps in measurement, quality care measures are an important aspect of treatment. Measuring the data on how we treat cancer patients is the only way to quantify progress and effectiveness of treatment. Accreditation also acts as an indicator of quality; more people diagnosed with cancer will choose an accredited institution over one that is not. It will be especially interesting to see where the value of care coordination factors into these measures as the value-based care proposition becomes more prominent over the coming years.
Of note: Cordata provides measures to its breast-only and oncology clients in the form of standard monthly reporting, in order to support accreditation and certification planning.