Identifying high-quality, cancer care is a laudable goal. However, a recent article by Alvarnas (2016) says the way many are trying to measure quality of cancer care currently is inadequate. Specifically:
- Quality and value are multidimensional, but the narrow focus of many quality measures undermines their effectiveness and meaningfulness. (Porter 2010)
- Quality and value measures are all too often based upon isolated care transactions, rather than based upon the continuum-of-care model that is an essential part of effective cancer care.(Porter 2010)
- Few quality/cost/value measures include risk as part of their formulation or expression. (Spinks 2011, CIBMR 2016)
- Electronic Health Records do not facilitate capture or assessment of key outcomes data.(Klumpp 2013)
- Few quality measures are linked to care strategy, healthcare facility/provider strategic planning, or the development of more effective care systems.(Porter and Lee 2015)
- Our measures for assessing patient-reported outcomes are weak, and rarely measure those things which matter most to patients.(Johnson 2016, de Boer et al. 2008)
So what’s the alternative to administrative quality measurement? Porter and Lee 2015 recommend the following:
The failure to prioritize value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians’ practices, which imposes substantial costs of its own. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.
That sounds like a better vision to me.
- Alvarnas, Joseph. So Many Metrics, Yet So Little Known About Quality and Value in Cancer Care. AJMC. Published June 9, 2016.
- Spinks TE, Walters R, Feeley TW, et al. Improving cancer care through public reporting of meaningful quality measures. Health Aff (Millwood). 2011;30(4):664-672. doi:10.1377/hlthaff.2011.0089.
- National Quality Forum website. http://www.qualityforum.org/Home.aspx. Accessed May 31, 2016.
- Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477-2481. doi:10.1056/NEJMp1011024.
- The six domains of healthcare quality. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/professionals/quality-patient-safety/talkingquality/create/sixdomains.html. Reviewed March 2016. Accessed May 31, 2016.
- Methodology employed for annual report on hematopoietic cell transplant center-specific survival rates. Center for International Bone Marrow Transplant Research website. https://www.cibmtr.org/ReferenceCenter/SlidesReports/USStats/Documents/CIBMTR_HCT_Center_Survival_Report_Methodology.pdf. Updated February 5, 2016. Accessed May 31, 2016.
- Klumpp TR. Electronic medical records and quality of cancer care. Curr Oncol Rep. 2013;15(6):588-594. doi:10.1007/s11912-013-0347-z.
- Porter ME, Lee TH. Why strategy matters now. N Engl J Med. 2015;372(18)1681-1684. doi:10.1056/NEJMp1502419.
- Johnson CY. The burden of cancer isn’t just cancer. The Washington Post website. https://www.washingtonpost.com/news/wonk/wp/2016/04/08/cancers-sinister-side-effect-financial-toxicity/?tid=a_inl. Published April 8, 2016. Accessed May 31, 2016.
- de Boer AGEM, Verbeek JHAM, Spelten ER, et al. Work ability and return-to-work in cancer patients. Br J Cancer. 2008;98(8):1342-1347. doi:10.1038/sj.bjc.6604302.