National Cancer Institute
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Outcomes Research Branch
Cancer Control and Population Sciences

Cancer Quality of Care Measures Project:

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Phase II Begins: May 2004

In May 2004, a partnership of four federal agencies -- the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and NCI -- completed contract negotiations with the National Quality Forum (NQF) to begin Phase II of the Cancer Quality of Care Measurement Project.

During this phase, the project conducted evidence-based reviews of available measures of cancer care quality to identify measures that are ready for use. The project also charted strategies for developing and testing new measures (though the development of new measures was beyond the scope of Phase II).

The Steering Committee for Phase II was convened (by conference call) in July 2004. At that time, the Committee selected three topics areas, from the seven priority areas identified in Phase I, as the focus of the Phase II analyses. These topic areas were symptom management and end-of-life care, breast cancer diagnosis and treatment, and colorectal cancer diagnosis and treatment.

For each topic area selected, NQF created a Technical Panel to evaluate candidate quality measures. These Technical Panels were informed by a thorough assessment of existing quality measures carried out by an AHRQ-funded evidence-based review. In addition, NQF staff issued a public call for measures for each topic area. The Panels evaluated the evidence from all sources and made recommendations to the Steering Committee on the suitability of candidate measures of cancer care quality and on future research priorities. A Data and Methods Panel also provided overarching guidance to the Technical Panels and the Steering Committee on the criteria for evaluating evidence and recommending candidate measures.

Cancer Quality of Care Measures Project
Phase II: Framework for 2004-2007

Flowchart illustrating relationships between panels and committees in the Phase II framework [D]

The Steering Committee delivered its recommendations to the NQF for consideration through its Consensus Development Process. NQF's four Member Councils and Board of Directors reviewed and voted on the Steering Committee's recommendations. NQF will use the results of the voting to publish core measures of cancer care quality as voluntary consensus standards.

The following six breast cancer quality of care performance measures were endorsed:

  • post-breast conserving surgery irradiation;
  • adjuvant chemotherapy;
  • adjuvant hormonal therapy;
  • college of American Pathologists Breast Cancer Protocol;
  • needle biopsy diagnosis; and
  • patients with early stage breast cancer who have evaluation of the axilla.

Four colorectal cancer performance measures also were endorsed:

  • adjuvant chemotherapy for stage III disease;
  • completeness of pathology reporting;
  • college of American Pathologists Colon and Rectum Protocol; and
  • surgical resection including at least 12 nodes.

Finally, nine symptom management, end of life measures were endorsed:

  • family evaluation of health care survey indicators;
  • comfortable dying;
  • chemotherapy in the last 14 days of life;
  • more than one emergency room visit in the last 30 days of life;
  • more than one hospitalization in the last 30 days of life;
  • intensive Care Unit admission in the last 30 days of life;
  • not admitted to hospice;
  • admitted to hospice for less than three days; and
  • death in an acute care setting.

Through this open and rigorous assessment of the evidence, and a deliberative process that brings a wide range of interested parties to the table, NCI believes this project will foster consensus about what constitutes quality cancer care in several important domains. This sets the stage for further advances in quality assessment and improvement, all aimed at reducing the suffering and death due to cancer.

Last modified:
27 Oct 2008
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