Hospital-based performance measures for quality of care for breast and colorectal cancer

In a move more than two years in the making, a National Quality Forum (NQF) endorsement became effective today of the first nationally recognized hospital-based performance measures for quality of care for breast and colorectal cancer.

The pioneering effort was led by the American College of Surgeons (ACoS) Commission on Cancer (CoC), working in concert with the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). The Commission on Cancer is a consortium of more than 40 professional organizations, including representatives from all medical disciplines that treat and care for cancer patients and are dedicated to improving the survival and quality of life for cancer patients. The CoC accredits over 1,400 cancer programs across the United States committed to providing the best in cancer care and are able to comply with established standards.

"This is an important advancement for the public and for the health care community because it marks the first time we have nationally accepted measures of quality for treating people with breast and colon cancer," according to Stephen Edge, MD, FACS, who co-led the ACoS Commission on Cancer's effort as chair of its Quality Integration Committee. "These measures help close the loop on quality improvement--data collected by hospitals and submitted nationally to the Commission on Cancer can now be used by hospitals and doctors to assess how they perform in comparison to others, and to address any issues in quality. The public can now have confidence that when their hospitals perform well in using these measures, they are receiving the nationally recognized standard of care as put forth by the nation's leading cancer organizations," Dr. Edge explained.

The measures endorsed by the NQF and put forth by the three cancer networks include:

Breast Cancer

• Radiation therapy is administered within one year of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.
• Combination chemotherapy is considered or administered within four months of diagnosis for women under 70 with hormone receptor negative breast cancer that is either larger than 1 cm with no nodal or distant organ metastasis, or has spread to involve regional lymph nodes but has not metastasized to organs outside the breast.
• Tamoxifen or third generation aromatase inhibitor (medication for breast cancer) is considered or administered within one year of diagnosis for women with hormone receptor positive breast cancer that is either larger than 1 cm with no nodal or distant organ metastasis, or has spread to involve regional lymph nodes but has not metastasized to organs outside the breast.

• Post-operative chemotherapy is considered or administered within four months of diagnosis for patients under the age of 80 with colon cancer that involves regional lymph nodes.

"The endorsement of these new cancer care measures by the National Quality Forum is an important step forward," said Agency for Healthcare Research and Quality director and NQF board member Carolyn M. Clancy, MD. "These measures, championed by leading cancer organizations and others, will help set clear standards for treating breast and colorectal cancer and help patients receive the best care possible."

In developing the measures, the organization members made the deliberate decision to evaluate the performance of hospitals and health care systems, not individual physicians. "Treating and managing cancer is an interdisciplinary, not a solo, practice; therefore, it was essential that we focused on hospitals and systems," according to Clifford Ko, MD, FACS, Director, Division of Research and Optimal Patient Care, American College of Surgeons and co-leader of the initiative.

Through its Cancer Program Practice Profile Reports (CP3R) and Electronic Quality Improvement Packets effort (e-QuIP) the CoC has positioned itself over the past two years to assist its more than 1,400 approved cancer programs to prepare for the arrival of these quality measures. The goal of these feedback reports has been to foster preemptive awareness of the importance of charting and coding accuracy and the improvement of clinical management and coordination of patient care in the multidisciplinary setting.

Commenting on this significant advancement in cancer patient care, Thomas R. Russell, MD, FACS, ACS Executive Director, said, "Through its Electronic Quality Improvement Packets effort (e-QuIP), the ACoS has already demonstrated that improvements in data quality and patient care are possible when the entire cancer community supports system-level enhancements to ensure complete and precise documentation."

"When credible quality measurement standards like these are in place, from a clinical perspective we think it is appropriate to link reimbursement by health insurance plans to standards of care," Dr. Ko said. "Consumers, patients and others need tools like these agreed-upon standards of care to measure quality of care. This is an important step in the so-called 'pay for performance' initiative."

The standard of care measures for breast and colon disease are now posted on the ACoS Web site at: http://www.facs.org/cancer/qualitymeasures.html. The measures are also on the Web sites of the ASCO (http://www.asco.org/qualitymeasures ) and NCCN (http://www.nccn.org/). The organizations will also proactively distribute the measures to the entire cancer community. The National Quality Forum first issued a call for breast and colorectal measures in 2004 and 2005.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 71,000 members and is the largest organization of surgeons in the world.