Establishing a system to monitor and evaluate the quality of cancer care in Japan.

Abstract

287 Background: To ensure equitable access to high-quality cancer care, efforts to routinely measure key performance indicators of cancer policy began in Japan in 2014. Although assessing the quality of cancer care is a vital component of this initiative, a system for evaluating process of care across a large number of hospitals has not yet been established. We aimed to establish this system by creating a database of health claims data linked to hospital-based cancer registry (HBCR) and measuring quality indicators (QIs) for cancer care. Methods: We created a database of 28 months (Sept10-Dec12) of health claims data linked to HBCR for 100,825 breast, prostate, colorectal, stomach, lung, liver, and cervical cancer patients who were newly diagnosed in 2011 from 178 designated cancer care hospitals in Japan. Among 206 QIs that were previously developed by a panel of experts, we measured 13 that were measureable from claims data: 1) seven QIs on adherence to guidelines on adjuvant therapy, 2) four QIs on lab tests, procedures, and medication, and 3) two QIs on supportive care. Results: QIs investigating adherence to clinical guidelines on adjuvant therapy tended to be lower compared to QIs for supportive care. For example, 48.0% [46.4, 49.6] of stage III colorectal cancer patients (n=3,638) received adjuvant chemotherapy (5FU+LV, UFT+LV, Cape, FOLFOX, or CapeOX) within 8 postoperative weeks, whereas 68.1% [67.2, 69.0] of patients (n=10,104) received three-drug combination (5HT3-r antagonist, dexamethasone, and aprepitant) before receiving highly emetogenic chemotherapy. QIs on appropriate testing and procedures were higher overall, such that 83.3% [82.6, 84.0] of invasive breast cancer patients (n=12,447) received HER2 testing. In all QIs, there was large variability in performance across hospitals. Feedback was given to hospitals through interactive webpages. Conclusions: This is the first attempt at measuring the quality of cancer care across such a large number of hospitals in Japan. Our research showed that in all QIs, there was ample room for improvement. Continuous monitoring, improving feedback methods, expansion of QIs, and application of electronic health records, will be our next challenge as we move forward in this initiative.