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Cancer Care Quality Measures
Evidence Reports/Technology Assessments, No. 138
Investigators: Meenal B Patwardhan, MD, MHSA, Principal Investigator, Gregory P Samsa, PhD, EPC Investigator, Douglas C McCrory, MD, MHS, EPC Investigator, Deborah A Fisher, MD, MHS, Clinical Investigator, Christopher R Mantyh, MD, Clinical Investigator, Michael A Morse, MD, MHS, Clinical Investigator, Robert G Prosnitz, MD, MPH, Clinical Investigator, Kathryn E Cline, MHS, Project Manager, and Rebecca N Gray, DPhil, Editor.
Structured Abstract
Objectives:
To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested.
Data Sources:
Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE ® (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet.
Review Methods:
Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal).
Results:
We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found.
Conclusions:
Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Question 1a: Colon Imaging, Endoscopic Visualization, and Biopsy
- Question 1b: Pathologic Staging
- Question 2a: Polypectomy for Malignant Polyps
- Question 2b: Surgical Therapy
- Question 2c: Adjuvant Chemotherapy
- Question 2d: Radiation Therapy
- Question 3: Colonoscopic Surveillance
- Question 4: Pathology, Operative, and Chemotherapy Reports
- Question 5a: Patient Populations and Purposes
- Question 5b: Age, Race/Ethnicity, and Socioeconomic Status
- 4. Future Research
- 5. Conclusions
- Acronyms and Abbreviations
- Appendixes
- References Cited in the Evidence Report
- Listing of Included Studies (alphabetical)
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0025. Prepared by: Duke Evidence-based Practice Center, Durham, NC.
Suggested citation:
Patwardhan MB, Samsa GP, McCrory DC, Fisher DA, Mantyh CR, Morse MA, Prosnitz RG, Cline KE, Gray RN. Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer. Evidence Report/Technology Assessment No. 138. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025.) AHRQ Publication No. 06-E002. Rockville, MD: Agency for Healthcare Research and Quality. May 2006.
This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0025). The findings and conclusions in this document are those of the author(s), who are responsible for its contents, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
- Review Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review.[Cancer. 2006]Review Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review.Prosnitz RG, Patwardhan MB, Samsa GP, Mantyh CR, Fisher DA, McCrory DC, Cline KE, Gray RN, Morse MA. Cancer. 2006 Nov 15; 107(10):2352-60.
- Review Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature).[J Eval Clin Pract. 2007]Review Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature).Patwardhan M, Fisher DA, Mantyh CR, McCrory DC, Morse MA, Prosnitz RG, Cline K, Samsa GP. J Eval Clin Pract. 2007 Dec; 13(6):831-45.
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- Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion.[Int J Evid Based Healthc. 2005]Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion.Callaghan A, Kendall G, Lock C, Mahony A, Payne J, Verrier L. Int J Evid Based Healthc. 2005 Jul; 3(6):147-67.
- Health-related quality of life in early breast cancer.[Dan Med Bull. 2010]Health-related quality of life in early breast cancer.Groenvold M. Dan Med Bull. 2010 Sep; 57(9):B4184.
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