FCCC LOGO Faculty Publications
Jadwin A , O'Grady P , Babb J , Engstrom PF
Feasibility of assessing quality in medical oncology practices
Cancer Practice. 2001 ;9(5) :231-5
Back to previous list
Abstract
Purpose: This study was designed to test the feasibility of conducting routine quality assessment within community medical oncology practices. Description of study: Eleven medical oncologists practicing within the Fox Chase Network were surveyed over an 8-month period, using a standardized 10-item checklist. Eight of the items (ie, board certification, continuing education, office procedure manual for chemotherapy, chemotherapy flow sheets, body surface area calculations, adherence to guidelines for follow-up of breast cancer, adjuvant hormones in women with estrogen receptor-positive breast cancer, and patient satisfaction survey) were chosen because they measure structural and process variables particularly relevant to the high-volume clinical services seen in private practice oncology. The authors also calculated two rates (protocol accrual and neutropenic complications of chemotherapy) to test as putative indicators of quality. Results: The authors found a high level of both physician interest in developing the audit measures and compliance with the survey process. Overall quality of care, as measured by structure and process variables, was excellent with negligible internal variability. Derived rates of protocol accrual (0.003-0.373; mean 0.11, SD 0.11) and neutropenic sepsis (0.004-0.014; mean 0.007, SD 0.004) show considerable variability, however, and are only minimally correlated (r = -.36). These are both potential indicators of quality that should be further evaluated. Clinical implications: The authors have demonstrated the feasibility of conducting quality assessment within private medical oncology practices and have identified two easily calculated rates that merit further study as potential indicators of quality.
Notes
Special Fields Contained : abstract, cited references. Special Interest Category: Oncologic Care Local Message: library has print only Locally Held: Yes Entry Week: 20020510 Cited References: Simone J. Ensuring quality cancer care. Washington, DC: The National Academy Press; 1999. Cited References: Goldberg KB ed. NCI to expand quality of care research, lead HHS panel on cancer care policy. The Cancer Letter 1999 October 1; 25. Cited References: National Committee on Quality Assurance. Available at: http://www.ncqa.org/pages/communications/news/h99meas.htm. Accessed August 10, 2000. Cited References: Lazar GS, Desch CE. Performance measurement in cancer care: uses and challenges. Cancer 1998; 82:2016-2021. Cited References: Piro L, Doctore J. Managed oncology care: the disease measurement model. Cancer 1998; 82:2068-2075. Cited References: Orred D. What the private sector does not know about purchasing oncology services. Cancer 1998; 82:2035-2038. Cited References: Mandelblatt JS, Ganz PA, Kahn KL. Proposed agenda for the measurement of quality-of-care outcomes in oncology practice. J Clin Oncol 1999; 17:2614-2622. Cited References: Shojania KG, Wachter RM. Unreliability of physician "report cards" to assess cost and quality of care. JAMA 2000; 283:52. Cited References: Scullion B, Knox K, Bennett CL. Quality improvement: carrots or sticks? J Clin Oncol 1999; 17:3859. Cited References: Smith MA, Atherly AJ, Kane RL, Pacala JT. Peer review of the quality of care: reliability and sources of variability for outcome and process assessments. JAMA 1997; 278:1573-1578. Cited References: Donabedian A. Evaluating the quality of medical care. Milbank Q 1966; 44:166-206. Cited References: Smith TJ, Davidson NE, Schapira DV et al. American Society of Clinical 1998 update of recommended breast cancer surveillance guidelines. J Clin Oncol 1999; 17:1080-1082. Cited References: American Society of Clinical Oncology. Criteria for facilities and personnel for the administration of parenteral systemic antineoplastic therapy. J Clin Oncol 1997; 15:3416-3417. Cited References: Carlson RW. (Panel Chair) for NCCN Breast Cancer Practice Guidelines Panel Members. Update: NCCN Practice Guidelines for the Treatment of Breast Cancer. Oncology 1999; 13:187-218. Cited References: Patient Satisfaction Survey. Rockledge, Pa: Oncology Physician Network; 2000. Cited References: Marin CG, Kennedy KF, Elting LS, Manzullo E, Escalante CP, Rubenstein EB. Incidence of emergency visits among oncology patients receiving outpatient chemotherapy: implications for care in a capitated market. Cancer Control 1996; 3:435-441. Cited References: American College of Surgeons. Standards of the Commission on Cancer. 1 section 6.2. Chicago, Ill: American College of Surgeons; 1995.