Quality of Care

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Quality of Care

• Steven B. Clauser, Ph.D.
• Chief, Outcomes Research Branch, NCI
• Applied Research Program
• Division of Cancer Control and Population
  Sciences
• NCCCP Kick off Meeting
• June 25, 2007

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NCI Cancer Care Delivery and Outcomes Group

• Joseph Kelaghan, PhD
• Jon Kerner, PhD
• Sarah Kobrin, PhD
• Lenora Johnson, MPH
• Holly Massett, PhD
• Helen Meissner, PhD
• Cherie Nichols, PhD
• Julia Rowland, PhD
• Stephen Taplin, MD, MPH
• Emmanuel Taylor, PhD
• Cynthia Vinson, MA

• Steven Clauser, PhD (co-chair)
• Arnie Potosky, PhD (co-chair)
• Ted Trimble, MD, MPH (co-chair)
• Tanya Agurs-Collins, PhD
• Neeraj Arora, PhD
• Rachel Ballard-Barbash, MD, MPH
• Martin Brown, PhD
• Andrea Denicoff, RN
• Brenda Edwards, PhD
• Paul Han, MD
• Diana Jeffrey, PhD

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Quality of Care Relates to Several Other NCCCP
Components
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What is quality?

• The degree to which health services for patients
  and populations
• -increase the likelihood of desired health
  outcomes,
• Are consistent with current professional
  knowledge, and
• Provide coordination and continuity of care
  throughout the entire cancer experience

Knowledge-based
Patient-Centered
Systems-minded
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To what extent is NCCCP cancer care
knowledge-based?

• Prevention Detection Diagnosis Treatment
  Survivorship End of Life
• Primary - Screening - Imaging -
  Local - Monitor health - Treatments
• - Prognostic - Systemic and HRQOL -
  Palliation
• Biomarkers - Trials - Recurrence
  - Hospice
• - Testing
  - Second
• - Biopsy Primary
• Identify evidence-based guidelines
• Compare treatment delivered to guidelines
• Evaluate degree of guideline adherence

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To what extent is NCCCP cancer care patient
centered?

• Global definition centers around
  provider-patient relationship and
  communicationunderstanding patient as a whole
  person
• Global metrics include all outcomes of interest
  to patient survival, satisfaction with care,
  and health-related quality of life
• Picker Institute defines patient-centered care
  more broadly        fast access to reliable
  health advice
•          effective treatment delivered by staff
  you can trust
•          involvement in decisions and respect
  for patients' preferences
•         clear, comprehensible information and
  support for self-care
•          physical comfort and a clean, safe
  environment
•          empathy and emotional support
•          involvement of family and friends and
  support for careers
•         continuity of care and smooth
  transitions

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Is NCCCP cancer care systems-minded?
Process of Care
OUTCOMES
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NCCCP quality of care is affected by multiple
levels of influence
Information Systems
OUTCOME Patient Health Status
Satisfaction Quality of Life
System Efficiency Equity Effectiveness
Information Systems
Delivery Site Leadership, Systems, Organization
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Strategic Approach

• Changing health care systems is the process of
  moving from the complex to the obvious in time
  consuming and expensive steps
• NCCCP proposed interventions therefore need to
  emphasize off the shelf and turn key solutions
  with high potential yield to both NCI and the
  pilot sites
• Also, need pilot site champions for buy-in and to
  move initiatives forward

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QoC Workgroup Program Principles

• Assess sites needs for internal program quality
  improvement
• Complements external program focus on health
  disparities
• Complement whenever possible NCCCP
  quality-related initiatives in clinical trials
  and survivorship
• Create infrastructure for sustained and ongoing
  quality improvement to support clinical and
  patient-centered performance
• Enhanced multi-disciplinary QI teams
• Enhanced patient support programs based on
  patient perspective of needs
• Measurement, intervention, feedback on select
  initiatives
• Compare results to pilot, NCCCP program, and
  national program trends

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Key Quality of Care Program Components

• Baseline Assessments of Quality Improvement (QI)
  Resources/Capabilities
• Enhance NCCCP infrastructure to support and
  maintain QI activities
• Focus on select opportunities linked to national
  or NCI initiatives
• QI Initiatives to Improve Evidence-based Care and
  Patients Satisfaction and Experience
• Sites select opportunities and improvement goals
  within broad NCI framework
• Baseline and Follow-up Assessments of both
  Process and Outcome improvement
• Compare when possible to site baseline, NCCCP
  program experience, and similar national programs
  

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Specific Research Questions

• Have the multi-disciplinary QI teams enhanced
  performance on systems-based measures?
• Referral for adjuvant therapy
• Provision of treatment summaries to patients
• Have the quality improvement initiatives
  increased adherence to evidence-based practice?
• Is there consistent improvement across sites?
• How does their improvement in clinical care
  compare to similar national providers or
  programs?
• Are tailored patient education/support programs
  associated with improved patient experience
• and quality of life?