Abstract
BackgroundNot all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care.MethodsPublished clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback.ResultsOnly 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient.ConclusionThe advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.
Highlights
Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem
Because this is not widespread in most jurisdictions we assigned feedback measures reliant on clinical stage to Category 2: core clinical registry; whereas those based on broader staging information such as recorded by States where population-based cancer registries (SEER)[13] were assigned to Category 1
Nearly half of the guidelines (119 or 49.0%) could be measured using a core clinical registry (Category 2), 88 (36.1%) required an expanded clinical registry or medical record review (Category 3) because they were based on information about follow-up or management of disease progression
Summary
Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. There is a perception, supported by some evidence, that not all cancer patients receive state-of-the-art care.[1,2,3] Providing regular feedback to clinicians might reduce this problem[1] and supporting this contention is a Cochrane review, which found that regular feedback can provide moderate,. In 1990, California's assembly debated new requirements for reporting clinical indicators to assess quality of care. When the cost of collecting the data items for the clinical indicators was estimated at $61 M, fiscal reality intervened and the legislature mandated the use of quality measures that used California's existing routinely-maintained databases.[7]
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