Understanding the drivers of cancer care at the regional, state, and local levels.

Abstract

142 Background: Regional, state, and local variations in cancer care necessitate a more thorough understanding of the key drivers of quality at these levels. In this study, Avalere sought to understand how local quality and health information technology (HIT) infrastructures may influence the quality of care to which a cancer patient has access. Methods: Avalere conducted an analysis of the primary influencers of quality and value in each state, cataloguing over 500 public and private quality improvement organizations, including payers; employer groups; and hospitals and alternative care delivery models, such as accountable care organizations and patient-centered medical homes, among others. Recognizing the critical role that health information technology (HIT) plays in underpinning quality improvement efforts, Avalere also catalogued the primary HIT organizations in each state. From this, Avalere conducted a sub-analysis of those initiatives with a specific focus on cancer care to determine how the number of cancer-related initiatives relates to the sophistication of a region’s or state’s quality and HIT sophistication. Results: Avalere found that the sophistication of the quality and HIT infrastructures varied widely from state-to-state and region-to-region, with some areas being significantly less developed than others. Similarly, the number of cancer-related quality initiatives also varied widely, with fewer initiatives found in areas with less sophisticated quality and HIT infrastructures. In addition, major urban areas tend to have significantly more sophisticated infrastructures—and an associated higher number of cancer-related initiatives—than non-urban areas, regardless of regional or state quality or HIT trends, more generally. Conclusions: While national quality improvement efforts receive the most media attention and funding, patient care, including cancer care, is delivered at the local level. As such, in order to improve the quality and value of care cancer patients receive, it is imperative to understand and improve local quality and HIT infrastructures and the barriers to quality associated therewith. This is particularly important in locales without major urban access, such as found in large parts of the Midwest and West.