The rapid quality reporting system: Assessing and improving the quality of cancer care with a prospective clinical performance tracking and reporting system.

Abstract

286 Background: The Rapid Quality Reporting System (RQRS), developed by The Commission on Cancer of The American College of Surgeons, allows accredited cancer programs to prospectively monitor adherence to five National Quality Forum endorsed quality of care metrics for breast (BC) and colon (CC) cancer. This study assesses differences in performance rates by patient populations and demonstrates the impact a prospective clinical performance tracking system can have in impacting care. Methods: RQRS tracks and measures compliance with the following measures: Radiation therapy within one year of diagnosis (dx) for women <70 receiving breast conserving surgery for BC (BCS/RT); hormone therapy within one year of dx for AJCC T1c, N0M0, or stage II or II; hormone receptor positive BC (HT); multi-agent chemotherapy within four months of dx; age < 70; hormone receptor negative BC (MAC); adjuvant chemotherapy within four months of dx; age <80; AJCC stage III CC (ACT); pathologic examination of ≥12 regional lymph nodes for surgically resected CC (12RLN). 64,129 RQRS measure eligible cases diagnosed from 2006 to 2010 from 64 RQRS beta test centers were assessed. Performances rates, before and after implementing the RQRS beta test, were compared by patient demographics. Results: Between 2006 to 2010, compliance rates increased significantly for all five measures, ranging from a 16% increase for MAC to 36% for HT. Prior to RQRS participation, BCS/RT, HT and ACT compliance was significantly lower in patients of other races cf. to white and black; for MAC, other races were lower cf. to white. By 2010 a difference by race remained only in BCS/RT. Payer status and age also impact care. Private insurance cases were more likely to receive compliant care for BCS/RT, MAC and 12RLN; with Medicare for HT (p<.05). Age impacted HT (<40 less likely) and ACT (70-79 less likely cf. to 40-49) (p<.05). Conclusions: Increased performance rates show a system which promotes the ability to track patients in real clinical time can improve quality of care. By using RQRS to prospectively monitor expected adjuvant care, programs can proactively intervene and address potential issues that could impede delivery of timely standard of care.