A large study reports that a new real-time performance tracking system, which monitors adherence to five National Quality Forum endorsed quality care metrics for breast and colon cancer, significantly improved quality standard adherence rates over a four-year period in a group of 64 cancer centers participating in the Rapid Quality Reporting System or RQRS ?beta test.? Use of the system also reduced reported differences in care related to age, race and health insurance status.

The study was released in a presscast today in advance of ASCO?s inaugural 2012 Quality Care Symposium. The Symposium will take place November 30 ? December 1, 2012, at the Manchester Grand Hyatt in San Diego.

Rapid Quality Reporting System is a voluntary web-based data collection and reporting system that is enabled through the National Cancer Data Base (NCDB), a nationwide oncology outcomes database of all Commision on Cancer (CoC) accredited cancer programs in the United States and Puerto Rico. Unlike other currently available quality tracking systems for medical care, which carry out performance assessments retrospectively, the RQRS, assessed in this study, provides feedback in real clinical time while the patient is still under active treatment.

Quality Measures
The reporting system wasdeveloped by the Commission on Cancer of the American College of Surgeonsto assess how well CoC-accredited cancer programs adhere to specific cancer care recommendations called quality measures [a] when caring for patients with breast, colon, or rectal cancer. There are six quality performance measures that are monitored, all are defined by the Commission on Cancer and five are endorsed by the National Quality Forum (NQF). Four of these measures are considered to be the standard of care based on clinical trials evidence (accountability measures) and two are considered to be indicators of good clinical care (used for quality improvement or surveillance purposes).

The CoC, through its National Cancer Data Base (NCDB), has the only system available in the United States to apply these quality measures and feed data back to cancer providers caring for the majority of U.S. cancer patients. This system in turn allows them to evaluate and improve the care they provide across all aspects of cancer care.

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“A key issue in cancer care is that people require treatment over a period of time, often administered by a number of different doctors in different specialties, such as surgeons, radiation oncologists, and medical oncologists,” said Stephen Edge MD, FACS, Chair of the Commission on Cancer. “Until RQRS, there has been no coordinated way to help track whether people get appropriate care,” he said.

Corrective Action
The rapid quality reporting system offers operates in real clinical time, thus enabling cancer clinicians to get immediate feedback from NCDB on their submitted cases. Previously such feedback has taken up to two years to be delivered to a cancer patient’s interdisciplinary cancer team. As a result, RQRS functions as a proactive tool that works to keep patients visible. ?When it identifies gaps in care, RQRS proactively alerts health providers so they can take corrective action,? said co-author on the study Andrew Stewart, Commission on Cancer, American College of Surgeons. ?Real-time performance tracking is easy to integrate within a cancer setting, using the same standard reporting procedures that hospitals already use to submit patient data to cancer registries. To our knowledge, this is the only disease specific treatment monitoring system in the country.? The systemensuring that patient don?t fall by the wayside. This alert mechanism may assist cancer programs in augmenting the patient navigation standard that is now required for all CoC-accredited programs.

Performance rates
The study assessed performance rates (specific quality care measures) for 64,129 eligible patient cases treated in the participating RQRS testing centers. Between 2006 and 2010, the greatest observed change was found in the reported receipt of hormone therapy for breast cancer, increasing from 47% in 2006 to 85% in 2010. Performance rates differed by patient age, race, and payer status (private insurance vs. Medicare), but the relative number and size of those disparities was reduced with fewer differences being observed between patients based on race, insurance status and age among patients seen in participating programs two years after implementation of RQRS compared to baseline data.

Adhering to Quality Measures
On a monthly or quarterly basis, participating hospitals submit data on their current breast or colorectal cancer cases. The system reports back year-to-date performance rates so hospitals can see how well they
are adhering to quality measures, promptly alerting doctors when quality measures are not being met.

Follow up Patient care
Physicians, cancer registrars, and cancer program administrators have access to the feedback. Some hospitals work with patient navigators to follow up on patient care. ?The benefit to patients who go to hospitals that are participating in the RQRS is that their providers are
utilizing an additional resource outside of the traditional patient physician relationship to enhance the successful coordination of patient care,? said Erica McNamara, MPH, Commission on Cancer, American College of Surgeons.

Future development
RQRS was started in 2006 with 6 alpha test hospitals. The beta test of the system began in 2009 with 64 participating programs. In 2011, the system was released on a voluntary basis to all Commission on Cancer accredited hospitals. About 350 programs are currently using the system. The researchers are developing additional clinical process measures to expand the use of RQRS to lung, stomach, and esophageal cancer.

Commenting on the study, Jyoti Patel, MD, ASCO Committee member said:?Ensuring that our patients receive the highest quality care possible is a core responsibility of oncology. The studies presented today show us new strategies for measuring and improving our adherence to quality standards.These findings provide insight on discussing treatment options for patients with both early-stage and advanced cancers.?

For more information:

McNamara EJ,Stewart A,Greer Gay E,Banasiak J,Palis BE,Edge SB. The rapid quality reporting system: Assessing and improving the quality of cancer care with a prospective clinical performance tracking and reporting system. J Clin Oncol 30, 2012 (suppl 34; abstr 286)

General Session: II
Abstract: #286
Title: The rapid quality reporting system: Assessing and improving the quality of cancer care with a prospective
clinical performance tracking and reporting system.
Authors: McNamara EJ, Stewart A, Greer Gay E, Banasiak J, Palis BE, Edge SB.
Presentation: Erica McNamara, MPH, Commission on Cancer, American College of Surgeons
Title: Models That Work: Integration across the Spectrum (Part II)
Date: Friday, November 30, 2012, 4:00 – 4:10 PM PST
Location: Douglas Pavilion B Chicago.

[a] RQRS tracks Radiation therapy within one year of diagnosis (dx) for women <70 receiving breast conserving surgery for BC (BCS/RT); hormone therapy within one year of dx for AJCC T1c, N0M0, or stage II or II; hormone receptor positive BC (HT); multi-agent chemotherapy within four months of dx; age < 70; hormone receptor negative BC (MAC); adjuvant
chemotherapy within four months of dx; age <80; AJCC stage III CC (ACT); pathologic examination of ?12 regional lymph nodes for surgically resected CC (12RLN).

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