delivered in America varies greatly by geography and setting, and different models of excellence are likely to emerge to suit specific environments.
Presenter: Dr. Patricia Ganz
Several years ago, as the American Society of Clinical Oncology (ASCO) embarked on the National Initiative on Cancer Care Quality (NICCQ), it became very apparent to the highly skilled health services researchers who were running that project how arduous it was to collect oncology data from medical chart reviews. The study involved reviews of 1,600 patients in multiple cities. Unlike other data collection efforts related to diabetes, arthritis, and heart disease, the review of oncology care was complicated by records being in multiple places, completed by different kinds of providers, and organized in a nonstandard fashion. The record abstractors felt lucky if the record included an initial consultation note that might have spelled out the planned treatment or a flow sheet that captured the course of treatment received. Often, however, a nurse abstractor had the arduous task of going through every page of the record to find out what drug doses were delivered and if a doctor followed the recommended prescription for the adjuvant therapy.
It became clear to ASCO that if the professional society was going to advance quality-of-care assessment, there needed to be a better way of getting this kind of data in a systematic way. With the publication of the Institute of Medicine (IOM) report on cancer survivorship, it became clear that survivorship care planning depends on having accurate and accessible diagnostic and treatment information.
Dr. Deborah Schrag discussed in her presentation the steps that have been taken to establish the content for the treatment summary (see Chapter 2). To test the draft template, five oncologists involved in ASCO’s QOPI volunteered to try it in their group practices. Two versions were tested in practices, most of which did not have an electronic medical record; a paper-and-pencil and a dictatable form. Both formats seemed relatively easy to use. The dictated form obtained more information because physicians may have felt obligated to go back through the chart and dictate it as they would a discharge summary. The paper version was completed more quickly than the dictated form.
Disease-specific formats are undergoing development to be tested further within the QOPI network because there are common regimens for treatment that can be prefilled, making completion of the form easier. For hematologic cancers, it may be difficult to decide when a patient needs an