Quality of cancer care among foreign-born and US-born patients with lung or colorectal cancer

Purpose To assess patients' experiences with cancer care, ratings of their quality of care, and correlates of these assessments. Patients and Methods For 4,093 patients with lung cancer and 3,685 patients with colorectal cancer in multiple US regions and health care delivery systems, we conducted telephone surveys of patients or their surrogates in English, Spanish, or Chinese at 4 to 7 months after diagnosis. The surveys assessed ratings of the overall quality of cancer care and experiences with three domains of interpersonal care (physician communication, nursing care, and coordination and responsiveness of care). Results English-speaking Asian/Pacific Islander patients and Chinese-speaking patients and those in worse health reported significantly worse adjusted experiences with all three domains of interpersonal care, whereas white, black, and Hispanic patients reported generally similar experiences with interpersonal care. The overall quality of cancer care was rated as excellent by 44.4% of patients with lung cancer and 53.0% of patients with colorectal cancer, and these ratings were most strongly correlated with positive experiences with coordination and responsiveness of care (Spearman rank coefficients of 0.49 and 0.42 for lung and colorectal cancer, respectively). After multivariate adjustment, excellent ratings were less common for each cancer among black patients, English-speaking Asian/Pacific Islander patients, Chinese-speaking patients, and patients reporting worse health status (all P ≤ .05). Conclusion Patients' reports and ratings of care differed significantly by race, language, and health status. Efforts to improve patients' experiences with cancer care should focus on problems affecting Asian and Pacific Islander patients and those in worse health.

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Quality of colorectal cancer care in Japan: A nationwide multicenter study.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.e16542 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. e16542-e16542 ◽

Cited By ~ 2

Author(s):

T. Higashi ◽

F. Nakamura ◽

K. Sugihara ◽

M. Ishiguro ◽

T. Shinkai ◽

...

Keyword(s):

Colorectal Cancer ◽

Multicenter Study ◽

Cancer Care

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Development of a comprehensive set of colorectal cancer care quality metrics.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.670 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 670-670

Author(s):

Laurence E. McCahill ◽

Jamie Kokko ◽

Chris Werkemma ◽

Pierson Ebrom ◽

Sarat Khandavalli

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Rectal Cancer ◽

Cancer Care ◽

Quality Metrics ◽

Care Quality ◽

Post Treatment ◽

Care Providers ◽

Care Surgery

670 Background: Institute of Medicine report calls for improved quality of cancer care. Numerous entities have sought measures of health care quality, but there is limited consensus regarding metrics for quality of colorectal cancer (CRC) care. Current measures are very limited; there exist no comprehensive metrics for quality of CRC care across the continuum of care. We sought to identify robust quality metrics, including measures related to pathology, coordination of cancer care, surgery, radiation, chemotherapy and surveillance, in order to identify gaps in quality of CRC care. Methods: National guidelines (NCCN and ASCO), National Quality Forum, and select peer reviewed publications were reviewed to develop evidence based metrics to assess quality of CRC care from diagnosis to post treatment surveillance and survivorship. A core group of health care providers, including a surgical oncologist, a pathologist and a Cancer nurse practitioner developed the metrics based on literature review. Measures were reviewed by key physician stakeholders including Radiation Oncology, Medical Oncology, General surgery, and Gastroenterology to obtain support for the quality initiative at our institution. Results: Twenty-three quality metrics were developed including 6 metrics related to access and process, 6 related to pathology, 7 related to multidisciplinary care and 4 measures related to surveillance and survivorship. Novel metrics included documentation of a three generational cancer family history, documentation of preoperative CT imaging of chest/abdomen/pelvis, MSI and KRAS testing in specific populations, appropriate pre-operative radiation oncologist evaluation for rectal cancer, multidisciplinary team planning prior to treatment initiation for rectal cancer and patients with newly identified liver metastases, appropriate referral for genetic counseling and surveillance annual CT scans for 3 years post treatment. Conclusions: These novel and comprehensive metrics allow for detailed review of the quality of CRC care received by patients at our institution. Individual patient data are currently being abstracted to assess the utility and logistics of implementing these quality metrics at a community cancer center.

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Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

Journal of Clinical Oncology ◽

10.1200/jco.2013.49.4302 ◽

2014 ◽

Vol 32 (8) ◽

pp. 809-815 ◽

Cited By ~ 23

Author(s):

Michelle van Ryn ◽

Sean M. Phelan ◽

Neeraj K. Arora ◽

David A. Haggstrom ◽

George L. Jackson ◽

...

Keyword(s):

Colorectal Cancer ◽

Supportive Care ◽

Cancer Care ◽

Quality Measurement ◽

Veterans Affairs ◽

Health Administration ◽

Patient Centered ◽

Patient Reported ◽

The Impact

Purpose High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. Patients and Methods Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. Results There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. Conclusion This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.

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Measuring Quality of Care in the Treatment of Colorectal Cancer: The Moffitt Quality Practice Initiative

Journal of Oncology Practice ◽

10.1200/jop.0722002 ◽

2007 ◽

Vol 3 (2) ◽

pp. 60-65 ◽

Cited By ~ 10

Author(s):

Paul B. Jacobsen ◽

David Shibata ◽

Erin M. Siegel ◽

Mihaela Druta ◽

Ji-Hyun Lee ◽

...

Keyword(s):

Colorectal Cancer ◽

Quality Of Care ◽

Cancer Care ◽

Medical Records ◽

Initial Phase ◽

Pathology Report ◽

Self Assessment ◽

Specific Level ◽

Lower Adherence

Purpose The Moffitt Quality Practice Initiative (MQPI) is a practice-based system of quality self-assessment, the ultimate goal of which is to improve the quality of cancer care at a statewide level. The initial phase of this project focused on developing procedures, determining feasibility, and evaluating utility for assessing quality of care for colorectal cancer within an existing affiliate network. Patients and Methods Representatives from four oncology groups selected quality measures consistent with evidence-, consensus-, and safety-based guidelines that could be abstracted from medical records. Trained abstractors then reviewed records of all eligible colorectal patients seen by each practice in 2004. Frequencies of responses for each indicator were tabulated for overall and practice-specific level of adherence and were compared among practices. Results Adherence was uniformly high for several indicators, including confirmatory pathology report, staging information, and chemotherapy discussion or recommendation. Lower adherence was evident across practices for performance of carcinoembryonic tests and complete colonoscopic evaluations. Significant variation among practices was evident only for consent for chemotherapy. Conclusion The initial phase of MQPI demonstrated the feasibility and utility of assessing quality indicators for colorectal cancer among members of an existing affiliate network. Findings identified areas where adherence to care was uniformly high, but also identified areas where both overall and practice-specific adherence were less than optimal. These efforts lay the groundwork for expanding MQPI in several directions that have in common the potential to improve the quality of cancer care on a statewide basis.

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