Community reporting on cost and quality in Washington state: Lessons learned.

Abstract

39 Background: As part of an ongoing initiative to improve the quality and affordability of cancer care in WA state., the Hutchinson Institute for Cancer Outcomes Research (HICOR) releases open access reports showing cost and quality across several cancer care domains. Here, using the Agency for Healthcare Research and Quality’s (AHRQ) framework for quality reporting as a guide, we report processes, successes, challenges, and lessons learned. Methods: In 2014, HICOR began a transparent, inclusive, multi-stakeholder approach to identify priority metrics of oncology care quality and cost. Using a registry-claims database covering over 70% of cancer patients in WA state, HICOR constructed clinic-level adherence and episode costs for community-prioritized metrics. From 2018 to 2023, five reports were released. The 2018, 2019, and 2021 reports covered 4 domains (appropriate therapy, hospitalizations during chemotherapy, surveillance testing, and end-of-life care). The 2020 report compared quality measures between commercial and Medicaid-enrolled patients. The 2023 report expands the measure list to include biomarker and germline testing and timeliness of care. Between 2020 and 2022, HICOR reported on the impact of COVID-19 on cancer care in WA State. HICOR hosts an annual gathering of oncology practice leaders, payors, and patients to review findings, share best practices, and identify areas for regional research and quality improvement efforts. Results: HICOR’s processes relative to the AHRQ framework are summarized in the table. Conclusions: Community reporting of cancer cost and quality measure requires a flexible framework, balancing parsimony, relevance, and actionability of measures, transparency, and trust in methods, and providing multiple opportunities for feedback. Engaging the community in quality improvement research is critical but challenging due to unpredictability in funding. [Table: see text]