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BACKGROUND/RATIONALE:
Noting the need to reduce the time from positive screening test to diagnosis and increase the use of guideline concordant care, the VA Colorectal Cancer Quality Enhancement Research Initiative (QUERI), VA Office of Quality and Performance, and VA Advanced Clinic Access (ACA) Initiative have partnered to conduct the Colorectal Cancer Care Collaborative (C4), and Veterans Integrated Service Network (VISN) 1. The project also involves collaboration with the VA Offices of Patient Care Services, Undersecretary of Health for Operations and Management, and Information, and the Office of Research and Development
(ORD). C4 includes at least one team from each of the 21 VISNs (total of 28). Successful strategies for quality improvement developed by the teams will be disseminated VA-wide. In addition, a Cancer Care Quality Measurement System (CCQMS) will be developed with the goal of increasing the ability to map/describe the process of delivering cancer care, identifying potential targets for quality improvement, and monitoring the effects of cancer care quality improvement initiatives.
OBJECTIVE(S):
As part of the C4 project the, the Durham HSR&D Center of Excellence is collaborating with other C4 partners to develop a Cancer Care Quality Measurement System that will provide data on the quality of colorectal cancer care in the VA. Using established National Comprehensive Cancer Network (NCCN) guidelines and the VA Directive on Cancer Care as benchmarks for the standard of care, we will develop a quality measurement template that will be completed by each of the 28 facilities in the C4 collaborative. The template will include data elements that, when aggregated, will form measures for evaluating the quality of colorectal cancer care in VHA. These NCCN-based measures will: a) identify facility level gaps in care to patients; b) identify facility level deviations from established standards of patient care; c) identify system-wide gaps in care to patients; and d) identify system-wide deviations from established standards of patient care. During this development process, requirements for updating and maintaining the CCQMS will be identified so that our partners in OQP can disseminate it throughout the VA healthcare system will be established.
METHODS:
The Colorectal Cancer Care Quality Measurement System will collect data on patients from 28 VA facilities participating in C4 identified using a screening protocol using data form the Computerized Patient Record System (CPRS). This will be the first component of the quality measurement system.
The project team in Durham, in cooperation with various VA constituencies (e.g. Oncology Field Advisory Committee), has developed quality measures. A data collection tool developed in Durham will enable data from the multiple sources to be aggregated to create a report of the key quality indicators for colorectal cancer treatment. Given the variability of coding practices across sites, each site will be provided with a blank data reporting tool, standardized coding conventions, and detailed instructions for populating the tool with fields required for determination of quality indicators. Once populated, the data will be processed and quality performance reports will be generated in conjunction with the sites and distributed. The quality measurement system will have a modular design that will facilitate extension of the system to include additional quality indicators as needed.
Data will be collected for patients diagnosed with colorectal cancer from January 1, 2004-December 31, 2007. This first wave of patient identification will provide the opportunity to further develop and refine our patient identification, data abstraction, and potential data extraction techniques.
FINDINGS/RESULTS:
The Colorectal Cancer Care Measurement System is currently being used by the facilities participating in the VA Colorectal Cancer Care Collaborative. As of February 2008, facilities have entered information on approximately 1,400 patients with the goal of targeting and monitoring efforts to improve the care of veterans with colorectal cancer.
IMPACT:
This effort will support the VA's goal of improving cancer diagnosis and care for our nation's veterans. Specifically, the project will establish a Cancer Care Quality Measurement System that it can be disseminated throughout the VA healthcare system. The CCQMS will improve VA's ability to specifically target and monitor cancer care quality improvement with the goal of optimizing care of veterans. While the initial focus is on colorectal cancer treatment within the VA, the anticipation is that the system can be expanded to other cancers and used by additional healthcare organizations.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Quality of Care
Keywords:
Cancer, Quality assessment, Quality assurance, improvement
MeSH Terms:
none
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