National Cancer Institute
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Outcomes Research Branch
Cancer Control and Population Sciences

Quality of Cancer Care Committee (QCCC):


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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Last modified:
04 Dec 2008
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