Ensuring Quality Cancer Care (1999) / Chapter Skim
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WHAT IS THE STATE OF THE CANCER CARE "SYSTEM"? The National Cancer Policy Board began its deliberations on quality by trying to describe what an ideal cancer care system would look and feel like from the vantage point of an individual receiving cancer care.
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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.
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Treatment of early breast cancer saves lives, and early detection through screening contributes to early diagnosis, when treatment is most effective. When established quality measures have been used to assess the care women receive, the following quality problems have been identified: · underuse of mammography to detect cancer early; · lack of adherence to standards for diagnosis (e.g., inadequate biopsies, poor reporting of pathology studies)
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The reasons for failure to deliver high-quality care have not been studied adequately, nor has there been much invesligation of how appropriate standards vary from patient to patient. The means for improving the quality of cancer care, which involve changes in the health care system, are the first five of a total of ten recommendations of the National Cancer Policy Board.
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As large health care purchasers, both sectors have a stake in improving the quality of care, and both sectors have knowledge and experience concerning quality measurement and reporting. A public-private collaborative approach has recently been recommended by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, and some initial implementation steps are being taken (President's Advisory Commission, 19981.
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There are many opportunities to exert leverage on the health care system to improve quality. Quality assurance systems are often not apparent to consumers, but have the potential to greatly affect their care: · large employer groups are holding managed care plans accountable for quality performance goals; · the Health Care Financing Administration (HCFA, which funds Medicare and the federal component of Medicaid)
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From page 7... ...
Large purchasers, such as employers are likely to exert more leverage and to have designated staff to assess alternative plans. Cancer care quality measures should be disseminated widely and communicated to purchasers, providers, consumer organizations, individuals with cancer, policy makers, and health services researchers, in a form that is relevant and useful for health care deci · ~ slon-maklnge Quality measures enable consumers and purchasers to judge the quality of a system of care by its performance relative to evidence-based standards.
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RECOMMENDATION 6: Federal and private research sponsors such as the National Cancer Institute, the Agency for Health Care Policy and Research, and various health plans should invest in clinical trials to address questions about cancer care management. For some questions regarding cancer management, a health services research component could possibly be integrated into a clinical trial designed to assess the efficacy of a new treatment.
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cancer registry, maintained by the National Cancer Institute (NC0, when linked to Medicare and other insurance administrative files, has been valuable in assessing the quality of care for the elderly and other insured populations. It is also useful in identifying a sample of cases for in-depth studies of qualityrelated issues.
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An annual report that provides a description of the status of cancer-relatec] quality-of-care research, and summarizes relevant published literature in the area would serve as a valuable resource for health services researchers and those involved in quality assessment.
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Individuals who have low educational attainment or are members of certain racial or ethnic minority groups face higher barriers to receiving cancer care and tend to have less favorable outcomes than other groups.* Limited access to primary care and cancer screening contributes to having cancer diagnosed at latter stages when prognosis is worse.
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From page 12... ...
National Academy Press. President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
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