How do we measure quality in Medical Oncology? Quality indicators in oncology practice
|Date||29 September 2012|
|Event||ESMO Congress 2012|
|Session||Excellence in care and chemotherapy: Goals and challenges for the oncology team|
|Topics|| Bioethics, Legal, and Economic Issues
The presentation reflects on the current debate on quality assurance in oncology. A central issue is raised on the questions of measurement. Quality monitoring in medicine must rely on clearly defined targets displayed by countable items. The challenge is to identify such reliable and frequently seen parameters that are associated with high standards of care.
Quality measures must be based on the best evidence that is usually provided by guidelines. Transforming guidelines into specific quality measures is a complex approach that has to consider detailed criteria for calculating numerator and denominator. The Rand/UCLA method or comparable techniques are widely recognized for developing quality measures and the development process itself relying on quality standards.
Meaningful quality measures focus on items of process quality. Outcomes in oncology often require longer lasting periods confounded with multiple interventions, which hinder practice benchmarking. Therefore, only treatment processes that are routinely delivered in a multitude of similar treatment sides can be monitored.
WINHO has defined 46 quality measures for oncology practices out of a sample of 67 measures that have been selected from literature concerning medical oncology treatment in general and treatment of breast and colorectal cancer in particular. Starting with 6 measures, we pilot data collection in a retrospective approach with study nurses abstracting charts in a few tens of practices. The model is derived from ASCO’s QOPI that now is in its 6th year.
First experiences in Germany reveal that a great number of oncologists are ready for participation but there are also complex demands for a uniform and complete data collection. The most challenging task is the plotting of the free text documentations. The central issue of implementing quality measures lies within the problem of documentation tools that can be used routinely in oncology practice and do not enlarge bureaucracy. Besides data collection, we are going to deal with questions of benchmarking reports, because feedbacks do not make sure that data can be translated into quality improvement.