Assuring continuous quality improvement using outcomes data: A potential role for cancer registries.

Abstract

6129 Background: There are increasing demands for transparency in health care, including making cost and outcome data more readily available to consumers and payers in order to define the quality of care delivered. Survival is a specific, significant, easily attainable, and relevant metric of the quality of cancer care, that is influenced by early detection procedures, treatment by various cancer specialists, and management of co-morbid medical conditions. Survival can be reliably measured because the date of diagnosis of invasive cancer can be ascertained from pathology reports and date of death is a well-documented vital statistic. Methods: We used the cancer registry of a 498-bed not-for-profit community hospital to identify the cohort of patients diagnosed with invasive cancer during 1989 to 2003. Standard computerized reports were generated for the entire cohort and for each of 24 specific tumor types, using computer software designed for this purpose (Electronic Registry Systems, Inc., Cincinnati, OH). Data included demographics, histology, stage, treatment, and actuarial survival curves. Timely follow-up was maintained on more than 90% of patients for 5 years after diagnosis. Results: In the internal benchmark comparison for the years 1989-1995 and 1996-2003, observed 5-year survival rates increased by 6 percentage points for the entire population, were higher for 18 of 24 specific tumor types, and unchanged for two. This improvement was associated with earlier diagnosis and increased use of systemic therapy. 5-year relative survival rates were higher than published Surveillance, Epidemiologic, and End Result (SEER) rates overall, and for 23 of 24 specific tumor types during 1996-2003 compared to 17 of 24 during 1989-1995. Survival for cancer patients improved over time and at a faster rate than observed nationally. Conclusions: Cancer registry data can be used to assess survival as an outcome measure and for comparisons to internal and external benchmarks. Other information routinely collected in cancer registries can be used to suggest which variables have been associated with changes in outcomes over time. When combined with cost data, survival could be used to determine the cost/benefit, or value of care. No significant financial relationships to disclose.