TABLE 6.1

Oncology Indicators of the JCAHO's IMSystem

 

Data

Staging

Breast Cancer

Lung Cancer

Colon or Rectum Cancer

Focus

Availability of data for diagnosis and staging

Use of staging by managing physicians

Use of tests critical for prognosis and clinical management of female breast cancer

Effectiveness of preoperative diagnosis and staging

Comprehensiveness of diagnostic workup

Numerator

Patients undergoing resection for primary cancer of the lung, colon or rectum, or female breast for whom a surgical pathology consultation report is present in the medical record

Patients undergoing resection for primary cancer of the lung, colon or rectum, or female breast with stage of tumor designated by a managing physician

Female patients with Stage I or greater primary breast cancer who, after initial biopsy or resection, have estrogen receptor analysis results in the medical record

Patients with non-small-cell primary lung cancer undergoing thoracotomy with complete surgical resection of tumor

Patients undergoing resection for primary cancer of the colon or rectum whose preoperative evaluation by a managing physician included examination of the entire colon

Denominator

Patients undergoing resection for primary cancer of the lung, colon or rectum, or female breast

Patients undergoing resection for primary cancer of the lung, colon or rectum, or female breast

Female patients with Stage I or higher primary breast cancer undergoing initial biopsy or resection

Patients with non-small-cell primary lung cancer undergoing thoracotomy

Patients undergoing resection for primary cancer of the colon or rectum

 

SOURCE: IMSystem, 1997.

National Committee for Quality Assurance

The National Committee for Quality Assurance (NCQA) accredits managed care plans and has produced a widely used report card monitoring system called the Health Plan Employer Data and Information Set (HEDIS). As the name implies, HEDIS measures were initially designed to provide information to large purchasers about the quality of care offered to employees. More recently, the audience for results from HEDIS has broadened, and HEDIS indicators are often reported in consumer-oriented report cards.

HEDIS is a performance measurement tool designed to assist purchasers and consumers in evaluating managed care plans and holding plans accountable for the quality of their services. Because HEDIS has standard measures and uniform data reporting requirements, comparisons can be made across various health plans and their organizational structures (e.g., staff-model HMOs, point-of-service plans). The most recent iteration, HEDIS 3.0, assesses plans in eight domains: (1) effectiveness of care, (2) accessibility and availability of care, (3) satisfaction with care, (4) cost of care, (5) stability of the health plan, (6) informed health care choices, (7) use of services, and (8) descriptive information about the plan. In addition to the standard set of measures, a set of measures not used in current scoring is being tested for future iterations of HEDIS (Box 6.4). NCQA has appointed an Oncology Measurement Advisory Panel to review quality measures relevant to cancer care.



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