ASCO Quality Care Symposium 2016 Exemplars in Quality and Identifying High-Quality Practice: Delivering Quality in the Community Setting (Bon Secours St Francis Cancer Center).

Abstract

On the basis of data from the American Cancer Society and the National Cancer Institute, greater than 85% of cancer patients are treated in community cancer centers (CCCs) within the United States. Although there have been avenues for community participation in therapeutic research for decades, the opportunities for contributing to the quality discussion have beenmore restricted. The small size of many community cancer programs and the lack of staff skilled in quality improvement (QI) methodology have limited substantive participation of CCCs in the QI discourse. In addition, there are unique features of CCCs that make the deployment of QI across the spectrum of organizations potentially problematic. These programs constitute a heterogeneous assortment of relationships between hospital and physician practice, including hospital-employed models, private practice, as well as free standing and hospitalaffiliated centers. Nevertheless, despite the potential difficulties associated with developing a standardized QI process for CCCs, there can be no movement toward the triple-aim goals of improved individual and population health care and reduced overall cost without substantive community participation, given the sizable role these organizations play in the provision of cancer care. At the 2016 ASCO Quality Care Symposium (QCS), the Bon Secours Saint Francis Cancer Center (BSSFCC) was honored with the opportunity to present our QI efforts as an exemplar from the community. Much of what I present in this article cannot be elevated to the level of conventionally “scientific” in that there are no clear end points, no inclusion/exclusion criteria, andno consensus-based assessment tools that unequivocally measure the effect of interventions. We have neither the size nor expertise to provide such data. Nevertheless, we at BSSFCCbelieve that CCCs can andshouldbe incubatorsofQI interventions despite these shortcomings. In many ways, the size of programs such as ours maymake us optimal sites to test novel concepts that might resonate with other organizations. Upon arriving at this year’s QCS, I noticed what was an apparent metaphor for this conundrum.Therewas a sign at the breakfast buffet that stated “Bran Muffins, made with gluten, prepared in a nut-free environment.” It was an inexpensive sign, yet it undoubtedly avoided harm to those who might have experienced significant morbidity from the ingestion of the muffins. I haveno ideahowmanypeople, if any,