Indicators Of Cancer Care Research Articles

Reproductive system cancer in females of the Tyva Republic. Epidemiological characteristics

Background. The incidence of female reproductive system cancer, including breast, cervical, ovarian and uterine cancers, is steadily increasing, and therefore it is advisable to conduct an epidemiological analysis and assess the quality of medical care. The purpose of the study was to analyze the epidemiological characteristics of reproductive system cancer in females of the Tyva Republic. Material and Methods. The reporting forms № 7 “Cancer incidence in the Tyva Republic” for 2013–2022 were used. Age-standardized incidence rates were calculated using the “Oncostat” program, and cancer care quality was assessed using “Cancer Care Indicators” program. Results. Reproductive system cancer in the Tyva Republic accounted for 46.3 % of all malignant neoplasms in females during 2013–2022. In 2022, breast cancer was the most common cancer (16.2 %) followed by cervical cancer (13.7 %), ovarian cancer (6.7 %), and uterine cancer (4.0 %). During the study period, none of these cancers showed a statistically significant increase in agestandardized incidence rates (AS R). In 2022, age-standardized incidence rates in the Tyva Republic were higher than those in the Siberian Federal District for cervical cancer (27.5 ± 3.7 vs 16.3 ± 0.4 0/0000) and for ovarian cancer (14.1 ± 2.8 vs 12.7 ± 0.3 0/0000), but lower for breast cancer (32.4 ± 4.1 vs 58.7 ± 0.6 0/0000) and uterine cancer (8.6 ± 2.2 vs 19.7 ± 0.4 0/0000). Overall, cancer care quality indicators for reproductive system cancers had improved. Active detection increased from 22.0 to 29.8 %, p=0.039 (in the Siberian Federal District: from 27.6 to 37.2 %, p=0.001). The detection rate at I–II stages increased from 53.7 to 75.2 %, p=0.004 (in the Siberian Federal District: from 63.0 to 71.3 %, p=0.001). The percentage of advanced stages decreased from 37.4 % to 15.5 %, p=0.001 (from 27.4 % to 23.1 % in the Siberian Federal District, p=0.013). The oneyear mortality rates also decreased from 19.0 to 5.4 %, p=0.013 (in the Siberian Federal District: from 11.8 to 8.5 %, р<0.001). The high incidence of cervical cancer, the absence of noticeable optimal changes in the early detection and the high prevalence of HPV infection among the female population of the Tyva Republic indicate the relevance of mass HPV testing as a part of secondary cancer prevention. Conclusion. The high incidence of female reproductive system cancer and the current status of reproductive cancer care in the Republic of Tyva dictate the need to strengthen primary, secondary and tertiary cancer prevention.

The impact of the COVID-19 pandemic on cancer incidence and cancer care in patients with prostate cancer in the Siberian Federal District

Background. Prostate cancer incidence rates continue to increase every year, therefore, the study of the quality indicators for cancer care, especially during a pandemic, is of great importance.Aim. To analyze prostate cancer incidence rates and quality indicators of cancer care in the Siberian Federal District.Materials and methods. For the calculation of cancer incidence rates, population-bases cancer registry data were used. Quality indicators were calculated according to the methodological recommendations of P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center.Results. The implementation of restrictive measures and the suspension of cancer screening programs in 2020 negatively affected the cancer care. The prostate cancer incidence rate decreased from 52.8 per 100 000 population in 2019 to 43.1 per 100 000 population in 2020, especially in the territories of the Republic of Tyva and the Omsk Region. Morphological verification in 2020 decreased compared to 2019 (97.0 % versus 97.8 %), with the exception of the Krasnoyarsk Territory and the Republic of Altai. Early prostate cancer detection increased from 62.9 to 64.0 %, and cancer detection at late stages decreased from 36.3 to 35.0 %. One-year mortality in the region decreased from 8.0 % (2019) to 7,3 % (2020), however, it increased significantly in the Republic of Tyva (from 3.2 to 40.0 %) and the Altai Republic (from 3.7 to 10.7 %). The number of patients who have been followed-up for 5 years or more increased from 40.7 to 42.3 %, except for Republic of Altai (from 32.8 to 25.0 %).Conclusion. Delay in the diagnosis of prostate cancer is associated with advanced stage, poor survival and high cost treatment.

THE IMPACT OF COVID-19 ON THE INCIDENCE OF RECTAL CANCER IN KAZAKHSTAN: RESULTS OF COMPONENT ANALYSIS

Relevance: Every year, 732,210 new cases of RC are registered globally, with an incidence of 7.6 per 100,000. The COVID-19 pandemic has affected the screening, case detection, and referral of patients with an asymptomatic cancer diagnosis.
 The aim was to assess the trends in rectal cancer incidence in the entire population of Kazakhstan before and during the COVID
 pandemics.
 Methods: The data obtained from the Ministry of Healthcare of the Republic of Kazakhstan concerning RC (Form no. 7) was retrospectively studied by descriptive and analytical epidemiology methods. The component method was used to analyze RC incidence dynamics
 based on the number of cases from 2010 to 2020.
 Results: From 2010 to 2020, the risk of getting RC went down. An increase in incidence in 2010-2020 (+24.8%) was lower than in
 the preCOVID period of 2010-2019 (+37.2%). We found a sharp decrease in RC incidence from 2019 to 2020. The overall decrease was
 0.89‰⁰⁰ due to changes in the age structure of the population (∑ΔA=+0.13‰⁰⁰), the risk of getting RC (∑ΔR=−1.02‰⁰⁰), and the combined
 impact of age structure and the risk of getting RC (∑ΔAR=−0.002‰⁰⁰). According to the component analysis, 1,662 patients with RC were
 expected in 2020; instead, only 1,471 cases were registered. Such a decline in cases was mainly due to a reduced risk of getting RC.
 Conclusions: The analysis of RC incidence trends in Kazakhstan shows a negative impact of COVID-19 on cancer care indicators and
 effectiveness. All oncological examinations were strengthened with the resumption of work after COVID restrictions. However, the number
 of screening visits remains lower than in previous years. Untimely diagnosis can increase the number of cases of late-stage CRC and an
 overall loss of years of life due to the lack of proper treatment. However, these forecasts can be mitigated by proper follow-up.

THE IMPACT OF COVID-19 ON THE INCIDENCE OF RECTAL CANCER IN KAZAKHSTAN: RESULTS OF COMPONENT ANALYSIS

Relevance: Every year, 732,210 new cases of RC are registered globally, with an incidence of 7.6 per 100,000. The COVID-19 pandemic has affected the screening, case detection, and referral of patients with an asymptomatic cancer diagnosis.
 The aim was to assess the trends in rectal cancer incidence in the entire population of Kazakhstan before and during the COVID
 pandemics.
 Methods: The data obtained from the Ministry of Healthcare of the Republic of Kazakhstan concerning RC (Form no. 7) was retrospectively studied by descriptive and analytical epidemiology methods. The component method was used to analyze RC incidence dynamics
 based on the number of cases from 2010 to 2020.
 Results: From 2010 to 2020, the risk of getting RC went down. An increase in incidence in 2010-2020 (+24.8%) was lower than in
 the preCOVID period of 2010-2019 (+37.2%). We found a sharp decrease in RC incidence from 2019 to 2020. The overall decrease was
 0.89‰⁰⁰ due to changes in the age structure of the population (∑ΔA=+0.13‰⁰⁰), the risk of getting RC (∑ΔR=−1.02‰⁰⁰), and the combined
 impact of age structure and the risk of getting RC (∑ΔAR=−0.002‰⁰⁰). According to the component analysis, 1,662 patients with RC were
 expected in 2020; instead, only 1,471 cases were registered. Such a decline in cases was mainly due to a reduced risk of getting RC.
 Conclusions: The analysis of RC incidence trends in Kazakhstan shows a negative impact of COVID-19 on cancer care indicators and
 effectiveness. All oncological examinations were strengthened with the resumption of work after COVID restrictions. However, the number
 of screening visits remains lower than in previous years. Untimely diagnosis can increase the number of cases of late-stage CRC and an
 overall loss of years of life due to the lack of proper treatment. However, these forecasts can be mitigated by proper follow-up

The results of the Comprehensive
 Cancer Control Plan
 in the Republic of Kazakhstan
 for 2018-2022 realization in 2019

Relevance: Cancer control is among the key social policy priorities in the Republic of Kazakhstan. 14,000 people
 die from cancer every year. As a result, our country faces an
 epidemiologic crisis caused by the increasing malignancy-related incidence and mortality, plus the increasing number
 of people living with cancer. In 2019, 186 326 patients with
 malignant neoplasms were under dynamic supervision in
 Kazakhstan; 52.5% lived for five years or more [1].
 WHO prognosis a 1.5-2 times growth of annual malignancy-related incidence and mortality worldwide by 2022.
 The Republic of Kazakhstan follows the same trend, taking
 into account the growing welfare and life expectancy of the
 population and an increase in the detection of malignant
 neoplasms due to the introduction of early detection programs [2].
 The purpose was to assess the implementation in 2019
 of the Comprehensive Cancer Control Plan in the Republic of
 Kazakhstan for 2018-2022.
 Results: Intermediate Comprehensive Plan implementation results showed the efficacy of the conducted measures
 as reflected by major cancer care indicators. Thus, the early detection has improved: stage 0-I detection amounted
 to 27.1% of all new cases (2019 target – 25.2%). This had a
 positive impact on cancer survival: in 2019, the proportion
 of 5-year or more survival was 54.7% for breast cancer (2019
 target – 54.5%), 56.8% for cervical cancer (2019 target –
 55.8%), 46.6% for colorectal cancer (2019 target – 45.8%) [1].
 Conclusion: The Comprehensive Cancer Control Plan
 implementation results evidence cancer care improvement
 in the Republic of Kazakhstan as of 2019 (increased 5-year
 survival and decreased mortality). However, a high share
 of detection of visually accessible malignant neoplasms at
 generalized and advanced stages should be addressed in the
 coming years.

System Performance Indicators for Adolescent and Young Adult Cancer Care and Control: A Scoping Review.

Adolescents and young adults (AYAs) with cancer represent a unique group with unmet needs. Metrics and quality indicators are important for evaluating AYA cancer care. The purpose of this study is to describe the quality indicators in a Canadian context that are used for AYA (15-39 years of age) cancer care and control. The Arksey and O'Malley methodological framework was applied to undertake a scoping review of the peer-reviewed and gray literature for indicators related to AYA cancer care and control. OVID Medline was searched from January 1995 until April 2018 for English language articles. Inquiries were made to AYA cancer organizations and a Google search conducted to identify unpublished material. Articles were included if they incorporated AYAs and contained cancer care indicators. Data were summarized at the article and indicator level. A total of 610 abstracts were reviewed. Eighty-nine full-text articles and reports were assessed for eligibility, with 19 included in analyses which identified 146 indicators or indicator concepts. Most of the indicators were specific to the AYA age group (65.8%) and dealt with the active care theme (57.5%), almost half focusing on guideline adherence and treatment (26.4%) and multidisciplinary/specialized care (20.7%). Notable deficits in indicators were in fertility, psychosocial care, and prevention. Important progress has been made internationally and within Canada on developing indicators for AYA cancer care and control. However, there is a lack of well-defined AYA-specific cancer care indicators developed through a consensus process.

Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality?

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.

Influencing Quality Reporting: Using the Rapid Quality Reporting System in a Community Network .

Value-based cancer care warrants an exploration of ways that nurses can influence quality for patients with cancer, particularly in the community setting, where the majority of patients with cancer are treated. . The purpose is to explore how community cancer centers met and sustained key quality breast cancer care indicators through implementation of the National Cancer Institute Community Cancer Centers Program Rapid Quality Reporting System (RQRS) and patient navigation projects. . The authors identified and interviewed staff at three sites that achieved significant increases in concordance with three breast cancer outcome measures. Three main themes emerged through analysis.

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

BackgroundThe evolution in the surgical and diagnostic procedures, the attention to women’s preferences, the case mix, and differences in professional practices may lead to a variability in the quality of breast cancer clinical pathway. To catch and manage this variability it is important to use valid measures. The aim of this paper is to examine the concurrent validity of the breast-conserving surgery (BCS) indicator and to provide evidence to guide the quality improvement process.MethodsThe BCS indicator was calculated using hospital discharge records (HDRs) and was validated against surgical registry (SR) data in a random sample of 336 women undergoing breast cancer surgery in 2012 in two Tuscan teaching hospitals. The concurrent validity of BCS was examined by cross-tabulating patients using the ICD-9 CM codes for breast surgery obtained from the two data sources.ResultsThe analysis, carried out involving breast cancer professionals, highlighted that the large majority of interventions coded as “mastectomies” in HDRs are in fact reconstructing procedures, including nipple-sparing, skin-sparing and skin-reducing mastectomies in SR. These results led us to refine the old algorithm, that calculates the proportion of breast-conserving surgery over the total number of breast interventions, and reclassify breast cancer surgical procedures into three categories: conservative, reconstructive and traditional mastectomy. Based on this new classification algorithm, the percentages of (I) reconstructive interventions were 16% at Florence TH and 38.3% at Pisa TH; (II) breast-conserving interventions were respectively 72.8 and 52.1%; and (III) mastectomies 11.2 and 9.6%. After adjusting for age in a logistic regression model, the percentages of reconstructive interventions at Florence and Pisa were respectively 22 and 34% and those of breast-conserving interventions 63 and 53%.ConclusionsOur results indicate that breast cancer care indicators should be refined by distinguishing reconstructive procedures (nipple/skin-sparing surgery with implant or breast tissue expander insertion) from traditional mastectomy. The involvement of breast care professionals in the choice of indicators proved to be crucial to capture the up-to-date breast cancer surgical practice and inform the quality improvement process.

Особенности организации онкологической помощи населению Республики Башкортостан и Российской Федерации и пути ее совершенствования

One of the important tasks of the state - is to reduce morbidity, mortality and disability due to malignant neoplasms. It can be solved through the protection of public health, including timely medical examination and rehabilitation, as well as promoting a healthy lifestyle. However, unfavorable ecological situation, the effects of widespread use of a variety of special equipment, deterioration of social well-being of the population and the abuse of tobacco and alcohol adversely affect the steady increase in the incidence of malignant tumors, and experts predict it is expected to further increase. Negative epidemiological situation on the malignancy has developed both in Russia and around the world. Oncopathology causing considerable economic damage to the country. All of the above leads to the relevance of a complex problem and requires further examination. In order to determine priorities in the organization of cancer care was necessary to study the state of oncology service data in the Republic of Bashkortostan in comparison with the all-Russian figures in dynamics for the last five years (2011-2015 gg.). The study found that the quantitative and qualitative indicators of cancer care in the Republic of Bashkortostan (active detection, timely diagnosis, morphological verification of the diagnosis, the five-year survival rate, index of accumulation of contingents, the incidence of malignant tumors) do not exceed the all-Russian figures. The dynamics for five years there has been a positive dynamics of the studied parameters, but about a quarter of patients who for the first time identified a cancer die within the first year after diagnosis. A study of performance indicators oncology service is of considerable practical interest because it can serve as a basis for planning the organization of oncological aid to the population, the development of national and regional anti-cancer program, to determine the required volume of curative and palliative care, the organization of medical and social rehabilitation of the sick and disabled. Improving cancer institutions in the country and the region will allow to provide specialized assistance to the population, corresponding to modern scientific and technical development of medical science, regardless of the place of residence of a particular patient.

THE NATIONAL ONCOLOGICAL PROGRAM IMPLEMENTATION – EXPERIENCE IN THE VLADIMIR REGION (TO THE 70TH ANNIVERSARY OF THE REGIONAL CLINICAL ONCOLOGICAL DISPENSARY)

By 2010, on the background of the steady increase in the incidence of malignant tumors in the Vladimir area, primary oncological care level worked inefficiently. Condition of material and technical base of the Vladimir Regional Clinical Oncological Dispensary was also unsatisfactory. All these problems required solution in the form of the National Oncology Program realization in the region. The National Oncological Program has begun to work in the Vladimir region since 2011. Target indicators of the oncological program implementation by 2015 were established. They are: Increase of 5-year survival value of patients with malignant tumors after diagnosis date to 51.4%; Increase the number of malignant tumors early detection cases at the I–II stages up to 51%; Decrease the mortality rate of working age population to 99 per 100 000; Decrease of mortality within one year from the first time of cancer diagnosis to 27%. The following main objectives such as radically improved the material and technical base of oncology dispensary; modern methods of prevention, diagnosis and patients treatment improvement and introduction; the system providing population cancer care focused on the cancer early detection and the specialized combined antitumor treatment provision are realized in order to achieve these goals. The implementation of the tasks allowed to achieve positive dynamics of Vladimir region population cancer care indicators. All the main targets of the National Oncology Program for the Vladimir region were achieved successfully. Implementation of the National Oncology Program has had an extremely positive effect on the cancer services development of, as well as for the health of the entire population of the Vladimir region.

Quality Oncology Practice Initiative Can Guide and Improve Oncology Providers' Training in Brazil.

PurposeIt has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital.MethodsASCO Quality Oncology Practice Initiative (QOPI) measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined.ResultsCertain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management, patients’ psychosocial status, and provision of a treatment summary at care completion.ConclusionThese findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.

Reporting and use of the OECD Health Care Quality Indicators at national and regional level in 15 countries.

OECD member states are involved since 2003 in a project coordinated by the OECD on Health Care Quality Indicators (HCQI). All OECD countries are biennially requested by the OECD to deliver national data on the quality indicators for international benchmarking purposes. Currently, there is no knowledge whether the OECD HCQI information is used by the countries themselves for healthcare system accountability and improvement purposes. The objective of the study is to explore the reporting and use of OECD HCQI in OECD member-states. Data were collected through a questionnaire sent to all OECD member-states containing factual questions on the reporting on all OECD HCQ-indicators. Responses were received between June and December 2014. In this timeframe, two reminders were sent to the participants. The work progress was presented during HCQI Meetings in November 2014 and May 2015. Fifteen countries reported to have a total of 163 reports in which one or more HCQIs were reported. One hundred and sixteen were national and 47 were regional reports. Forty-nine reports had a general system focus, 80 were disease specific, 10 referred to a specific type of care setting, 22 were thematic and 2 were a combination of two (disease specific for a particular type of care and thematic for a specific type of care). Most reports were from Canada: 49. All 15 countries use one or more OECD indicators. The OECD quality indicators have acquired a clear place in national and regional monitoring activities. Some indicators are reported more often than others. These differences partly reflect differences between healthcare systems. Whereas some indicators have become very common, such as cancer care indicators, others, such as mental healthcare and patient experience indicators are relatively new and require some more time to be adopted more widely.

Sharing experiences and building collective projects in quality management: The strength of UNICANCER group.

226 Background: UNICANCER is a hospital group entirely devoted to fighting cancer. UNICANCER groups together 20 French Comprehensive Cancer Centers (FCCC), which are private, non-profit establishments with a threefold mission of patient care, research and oncology teaching. They share the same organizational model to take care the patients and they have organized an informal network of quality and risk management In 2005, the FCCC federation (former Unicancer group) was created a Quality department in order to build a common approach to improve the quality of care and patient management in Cancer Centers. One the most important tools to set up this shared works were comparative analysis and feedback system. Methods: Every year, the quality department of Unicancer group coordinated the results of several indicators recorded by each centers. These results were summarized in the benchmarks dashboards to identify the priority actions for the group. Results: Between 2006 and 2014, some collaborative projects have been carried out in various fields: (1) development of the culture of continuous improvement, (2) involvement to the national implementationof hospital quality and safety indicators in France, (3) development of specific indicators of cancer care, (4) implementation of questionnaire survey to assess the in- or outpatient satisfaction. As far as concerned the different results of external assessment (1) the values of quality and safety indicators are above the national average, (2) the Cancer Centers have the best level of “certification” for the French National Authority for Health. Conclusions: The teamwork and benchmarking is an innovative way of working. The level of quality of care and patient management increases steadily in Cancer Centers in France. The next step consists of developing a common standard to keep competitive edge. [Table: see text]

Timing of adjuvant chemotherapy in stage III colon cancer as a measure of quality: Reasons for noncompliance.

640 Background: The Institute of Medicine's report on improving cancer care, along with the evolution of ASCO's Quality Oncology Practice Initiative, has helped to develop process measures into critical quality of cancer care indicators. One such measure relates to "receipt of chemotherapy for stage III colon cancer (CC) within 120 days of diagnosis" and is now being incorporated into processes including hospital accreditation (American College of Surgeons; ACS), managed care contracts and Center for Medicare and Medicaid Services (CMS) quality monitoring. To better understand potential pitfalls related to the strict guidelines of this measure, we sought to evaluate institutional adherence at a tertiary care cancer center and to examine the reasons for non-compliance. Methods: A retrospective review was performed of all cases of stage III colon cancer reported at a single institution from 2008 – 2012. Coding for compliance was performed using standard ACS guidelines. Results: A total of 122 eligible cases were identified and consisted of 49 (40.2%) women and 73 (59.8%) men with a median age of 58 (range 32 - 77). Overall, 15 (12.3%) cases were non-compliant with 2 (1.6%) lost to follow up. Of the non-compliant cases, 14 (93.3%) cases did go on to receive chemotherapy while 1 (6.7%) never received adjuvant treatment. Of those receiving delayed treatment, 7 were due to patient-centered factors [e.g. patient timing preference (n=4), request for chemotherapy closer to home (n=2) and lost to follow up (n=1)]. Other reasons included delays at outside facilities (n=4), postoperative complications (n=1) and insurance approval (n=1). In 2 cases, designation of date of diagnosis based on suspicion rather than definitive biopsy contributed to non-compliant status. Conclusions: Our center averaged an annual compliance with the CC adjuvant therapy measure of approximately 90%. Larger scale studies are indicated to determine whether refinements in coding guides that account for patient preferences, clear diagnosis dates and cross-facility care could better reflect quality of care, and also promote improved patient-centered multidisciplinary management.

Ongoing professional practice evaluation implementation within STATIT.

283 Background: The OPPE allows the organization to identify professional practice trends that impact quality of care and patient safety. The intent of the standard is that organizations are looking at data on performance for all practitioners with privileges on an ongoing basis, to allow them to take steps to improve performance on a more timely basis. Methods: Infrastructure development. We assigned people for data integration, technical support and metric development. The manager of Clinical Decision Support serve as the administrative coordinator to the program managed the progress of implementation. Leadership Support. To implement the STATIT for OPPE in any hospital, executive leadership support is required to secure funding and resources for the program as well as to support the quality improvement initiatives undertaken that will affect current policies and a wide range of personnel. The early support for the OPPE STATIT came from hospital’s administrative leadership and Performance Improvement leadership. Committed OPPE STATIT implementation team. The basic OPPE STATIT team, consisting of a Manager of Clinical Decision Support, two IT people, and ten Informatics Analysts, requires additional personnel such as departmental Quality Officer with differing expertise for indicator development. Results: All of medical knowledge, patient care activity, and system based indicators plus departmental specific cancer care indicators can be reviewed and any outliers can be drilled down for analysis by division head, department chair and quality officer and signed off on a six-month basis. All individual providers also are able to review his/her performance quality and peers’ comparison. Conclusions: The MIDAS + Statit Physican Profile & Review (PPR) solution is a Web-based system that allows medical providers easy access performance dashboards, which contain up-to-the-moment performance data, annual and interim reviews and drill down to patient level data. The information is necessary to align medical staff with key strategic objectives across the organization. It provides the statistical analysis of patient care quality and safety and opportunities of improvement.

Childhood cancer and pediatric oncologic care in Brazil: access and equity

Cancer in children and adolescents is rare and highly curable if treatment is started early, yet it is still the main cause of death from disease in this age group. The aim of this study is to discuss access to health services for cancer patients under 19 years of age in Brazil, mapping deaths and treatment modalities in the Brazilian Unified National Health System (SUS). Data from 2000 to 2007 were analyzed according to health regions. Maps of cancer mortality rates and cancer care indicators - hospitalizations, chemotherapy, and radiotherapy financed by the national health system - revealed inequality in access, based on the small number of procedures for children in poorer regions of the country. Even with the usual concentration of specialized services in more heavily populated areas, access begins with clinical suspicion in primary care, followed by referral to more complex levels, where the diagnosis is made and treatment begins. Training pediatricians in clinical suspicion of childhood cancer and definition of more streamlined patient flows could improve the situation, thereby increasing the odds of cure.