QCCC Collaborative Projects
Enhancing the Quality of Cancer Care in Health Resources & Services
Administration (HRSA)-sponsored Community Health Centers
This collaborative project between the Health Resources
and Services Administration (HRSA) and the Centers for
Disease Control and Prevention (CDC) was designed in 2001 to use a chronic care model
to develop "breakthrough changes" in HRSA-sponsored community health centers, with the
goal of improving screening, referral, and follow-up of breast, cervical, and colorectal
cancer for underserved populations. The project has documented increases in cancer
screening rates in participating health centers, and has resulted in expansion and
dissemination of effective interventions throughout the community health center system,
development of web-based learning tools for health center professionals, and generation of
ancillary research studies aimed at understanding health facility changes and refining
outcomes measurement.
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Improving Colorectal Cancer Screening
This collaborative project between the Centers for
Medicare and Medicaid Services (CMS) and Centers for
Disease Control and Prevention (CDC) was designed in 2001 to improve colorectal cancer
screening rates within the Medicare beneficiary population and their primary care
physicians in North and South Carolina. The project led to documented post-intervention
increases in colorectal cancer screening, and to descriptive findings of a lack of
physician recommendations for screening in more than 25% of the population sampled, and
racial disparities in screening. The project resulted in several published manuscripts
and the development of measures and intervention designs to be incorporated into further
quality improvement initiatives.
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Improving the Detection & Treatment of Colorectal Cancer
This collaborative project conducted by the Department of
Veterans Affairs (VA) was designed in 2001 to translate evidence into practice in
order to improve screening, surveillance, treatment, and end-of-life care in colorectal
cancer patients served by the VA health care system. (See the VA's Quality Enhancement Research
Initiative.) This ongoing project has generated valuable baseline data on screening
rates, practice variation, and physician- and system-level factors affecting the quality
of care of colorectal cancer patients. Data from this project have resulted in multiple
publications as well as ancillary research projects and quality improvement efforts in the
VA health care system.
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Improving Palliative Care in the Indian Health Service
This ongoing collaborative project conducted by the Indian Health Service was designed in 2004 to provide an
assessment of the current status of palliative care in the Indian Health Service system,
and to develop multidimensional interventions to improve palliative and end-of-life care.
Initial baseline assessment data from this project are currently being analyzed, and
further needs assessments and quality improvement projects are being planned.
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Augmenting National Ambulatory Medical Care Survey (NAMCS)
This collaboration with the National Center for
Health Statistics (NCHS) was designed in 2005 to support evaluation of national survey
instruments and the addition of a separate stratum of 200 medical and surgical oncologists
to the 2006 and 2007 NAMCS. This work has resulted in plans to assess redesign of the
National Hospital Discharge Survey, to add the additional separate stratum of oncologists,
as well as cancer control data elements into existing NCHS surveys aimed at collecting
nationally-representative data on health systems and physician practices.
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Evaluating the Medicare Oncology Demonstration Project
This collaborative project with the Centers for
Medicare and Medicaid Services (CMS) was implemented in 2006 to evaluate CMS national
demonstration projects aimed at reimbursing oncologists for providing outcomes data on
patient symptoms. Instrument development and data collection efforts are ongoing, and the
study findings will inform policy and future demonstration initiatives regarding the use
of payment incentives to enhance the collection of data on patient-reported outcomes data
and clinicians' adherence to clinical guidelines in office-based oncology practice
settings.
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Developing Core Quality Measures for End-of-Life Care
The QCCC is collaborating with the Agency for Health
Care Research and Quality (AHRQ) to support two projects aimed at developing and
testing measures of the quality of end-of-life care in cancer patients. The first project
used SEER-Medicare data as well as state-wide pharmacy claims data in New Jersey and
Pennsylvania to explore the usefulness, feasibility, and generalizability of existing
benchmarks for measuring the quality of end-of-life care in a prospective cohort of cancer
patients with a poor prognosis. Additionally, this study, which was completed in 2006,
developed and tested the usefulness of new claims-based indicators as measures of the
quality of end-of-life care. The second project, which began in late 2007, will develop
and evaluate a conceptual framework for measuring the quality of symptom management and
end-of-life care in cancer patients. Project activities include a symposium to obtain
feedback on the conceptual framework from key health care experts and stakeholders, and
evaluation of the utility of current databases and data collection initiatives for
measuring key concepts in the conceptual framework, pilot testing to evaluate the
feasibility of specific candidate measures, and the development of recommendations about
future measurement development and data collection efforts.
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National Quality Forum - Toward a Comprehensive Cancer Measure Set
In this collaboration, NCI and the Agency for Health
Care Research and Quality (AHRQ) are contracting with the National Quality Forum (NQF) to provide the QCCC
with recommendations for a research agenda to advance the science and application of
cancer quality measurement. It builds on prior work completed by the NQF on behalf of
QCCC members, as well as current work under the auspices of the NQF Priority Setting
Project, which has developed a measurement framework for evaluating efficiency -- defined
as quality and costs -- and ultimately the value of care across extended health care
episodes. This project sponsored a workshop, convened in May 2008, to bring in national
experts to create an action plan for developing the next generation of cancer quality of
care measures. The workshop identified quality gaps in cancer care, and described the
current state of quality measurement in cancer care, focusing on limitations of existing
performance measures. The workshop then focused on articulating and analyzing a new
framework for quality measurement based on "episodes of care," a patient-centered
perspective that goes beyond existing quality measurement frameworks in emphasizing care
transitions and coordination and the shared contribution of multiple care providers to the
overall quality of care over time. The conference proceedings will inform a white paper
on strategic research directions in cancer performance measurement co-authored by Peter
Bach, MD, Memorial Sloan-Kettering Cancer Center, and Michael Hassett, MD, MPH,
Dana-Farber Cancer Institute.
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Department of Veterans Affairs (VA)-Department of Defense (DoD) Colorectal Cancer
Quality Monitoring System
This QCCC collaboration between the Veterans
Administration (VA) and the Department of
Defense (DoD) is designed to develop and pilot a colorectal cancer quality measurement
and improvement system for veterans and military service personnel and families diagnosed
with colorectal cancer. The project will build off the medical record abstraction system
and patient/caregiver surveys developed in the Cancer Consortium for Outcomes Research
and Surveillance project and will incorporate both technical and interpersonal
indicators of quality of care. The first phase of the project (October 2007 - September
2008) will develop the patient survey instrumentation and case ascertainment protocols for
use in VA and DoD hospitals and modify the VA medical record abstraction tool for use in
DoD facilities. The patient survey will include domains pertaining to caregiver support,
physician and patient communication, and shared decision-making. The project team also
will select DoD facilities to pilot test the system. The second phase of the project
(October 2008 - December 2009) will pilot test the patient survey tool in select VA/DoD
hospitals and prepare documentation on how the colorectal cancer quality monitoring and
improvement system can be used in other cancer care delivery systems with electronic
health record capability. Final deliverables also will include descriptive reports
comparing quality of care in the VA and DoD health care systems and an analytical report
on the relationship between technical components of treatment effectiveness and
inter-personal indicators of quality.
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