TABLE 6.9

Compliance Rates of Medical Decisions with Guidelines, Lyon, France

 

Compliant with Clinical Practice Guidelines (%)

Type of Procedure

1993

1995

p Value

Breast Cancer

Initial evaluation

75

86

.09

Surgery

96

92

.26

Chemotherapy

71

85

.01

Radiotherapy

72

93

<.001

Hormonal therapy

83

94

.01

Follow-up

31

80

<.001

Overall treatment sequence

19

54

<.001

Colon Cancer

Initial evaluation

100

100

 

Surgery

100

99

.56

Chemotherapy

56

78

.02

Follow-up

62

54

.69

Overall treatment sequence

50

70

.009

 

SOURCE: Ray-Coquard et al., 1998.

Key Findings

Information about quality cancer care is becoming more available to individuals with cancer (or at risk for cancer), but it is not yet easily accessible to or understandable for consumers. A number of potential quality indicators can be listed, but most have not been evaluated to assess their ultimate value to consumers. It is unclear, for example, how the following indicators affect an individual's experience of care or health care outcomes:

  • a physician's board certification,
  • a hospital's approval status determined by the American College of Surgeons' Commission on Cancer, and
  • a health plan's accreditation status and HEDIS scores.

By the time a diagnosis of cancer is made and individuals have a clear reason to seek quality cancer care, it is often too late to switch health plans. Even if they could, however, many individuals do not have access to alternative plans. Individuals may use available quality indicators to choose doctors and hospitals within their plans, and perhaps to choose alternative courses of treatment, but evidence suggests that individual consumers can exert only a modest market pressure for quality improvement through access to better information about the quality of cancer care.

Quality assurance systems are often not apparent to consumers, but they have the potential to greatly affect care. Some large employer groups are beginning to hold health plans to



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