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The NCPB then described at least some aspects of a cancer care system that would support such an ideal state of care. A system of ideal cancer care would
articulate goals consistent with this vision of quality cancer care;
implement policies to achieve these goals;
identify barriers to the practice and receipt of quality care and target interventions to overcome these barriers;
further efforts to coordinate the currently diverse systems of care;
ensure appropriate training for cancer care providers;
have mechanisms in place to facilitate the translation of research to clinical practice;
monitor and ensure the quality of care; and
conduct research necessary to further the understanding of effective cancer care.
The NCPB has concluded that for many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care.
There is no national cancer care program or system of care in the United States. Like other chronic illnesses, efforts to diagnose and treat cancer are centered on individual physicians, health plans, and cancer care centers. The ad hoc and fragmented cancer care system does not ensure access to care, lacks coordination, and is inefficient in its use of resources. The authority to organize, coordinate, and improve cancer care services rests largely with service providers and insurers. At numerous sites in the federal government, programs and research directly relate to the quality of cancer care, but in no one place are these disparate efforts coordinated or even described. Efforts to improve cancer care in many cases will therefore be local or regional and could feasibly originate in a physician's practice, a hospital, or a managed care plan. Because cancer disproportionately affects the elderly, the Medicare program could be an important vehicle for change. Certainly, issues related to quality cancer care have to be addressed at the national and state levels, in coordination with other quality-of-care efforts. Of note is the creation of organizations to implement recommendations of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The commission recommended that broad national aims for quality improvement be set with specific measurable objectives and that, within each national aim, standardized sets of indicators be developed for use in all sectors of the health care system (President's Advisory Commission, 1998).
What is Quality Cancer Care and How is it Measured?
Health care can be judged as good to the extent that it increases the likelihood of desired health outcomes and is consistent with current professional knowledge (IOM, 1990). In practical terms, poor quality can mean
overuse (e.g., unnecessary tests, medication, and procedures, with associated risks and side effects);
underuse (e.g., not receiving a lifesaving surgical procedure); or
misuse (e.g., medicines that should not be given together, poor surgical technique).