Development of quality indicators for liver cancer care

Abstract

17500 Background: Appropriate management of liver cancer can significantly prolong survival and enhance the quality of life of patients. Although evidence-based practice guidelines to promote standards of care have been published, no systematically-developed quality indicators (QI) to assess or monitor care for hepatocellular carcinoma have been reported. Methods: Using a formal method combining literature review and expert opinion, we developed a set of process QIs for the care of hepatocellular carcinoma. We first identified candidate QIs based on the current clinical practice guideline sponsored by the Japanese government as well as literature review. Each candidate QI described the patients targeted and the standard of care that these patients should receive. The QIs were designed to be implemented through review of medical records. Next, a multi-disciplinary panel of nine clinical experts, including surgeons, internists, and radiologists, examined the candidate QIs and selected a final set through two rounds of anonymous rating of validity, between which a face-to- face consensus meeting was held. Results: total of 34 candidate QIs were evaluated by the expert panel. The panel added two QIs pertaining to the post-operative provision of information to the patient. After major modification of four other QIs, 25 QIs were finally rated as valid. This final set of QIs comprised 13 on appropriate choice and indications for treatment (e.g. surgical resection for solitary hepatocellular carcinoma of 3–5cm diameter), 5 on pre-treatment work-up (e.g. dynamic studies before treatment), and 7 on follow-up/post-treatment care (e.g. image study after chemoembolization). Conclusions: We developed a set of QIs to assess the care of hepatocellular carcinoma patients. These QIs will facilitate quality improvement efforts in liver cancer care. No significant financial relationships to disclose.