New approaches can improve cancer care delivery

Physicians can use medical records to track the quality of cancer care and determine whether their patients are receiving the right treatments at the right time. Yet the patient is the only one who ultimately can evaluate the quality of his or her experience while receiving treatment.

In "Quality Measurement and System Change of Cancer Care Delivery," published in the Regenstrief Conference supplement to the December 2011 issue of the journal Medical Care, investigators from the Regenstrief Institute and the Indiana University School of Medicine explore current cancer care quality measurement and discuss new ways to empower patients and promote system transformation to improve quality of care.

Cancer is the second leading cause of death after cardiovascular disease in the United States. However, the federal government and health care quality organizations have fewer reporting requirements for quality of cancer care than for treatment of many other diseases.

"As physicians consider treatment options for prostate, lung, breast and other cancers, they and the health care systems where they practice need to develop better tools to assess and measure the individual patient's values and preferences," said Regenstrief Institute Investigator David A. Haggstrom, M.D., a research scientist with the Center of Excellence on Implementing Evidence-Based Practice, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service in Indianapolis. He is an assistant professor of medicine at the IU School of Medicine and a member of the Indiana University Melvin and Bren Simon Cancer Center.

Dr. Haggstrom says that quality medical care cannot subscribe to the one-size-fits-all theory. Questions must be asked, he says, to determine what cancer care is most appropriate for each individual. Does the patient want to be heavily involved in his medical decisions or would he prefer not to be overloaded by information? Does the patient want aggressive treatment from her medical team or does she prefer more conservative approaches?

"We have developed a roadmap which we believe provides a pathway to improve quality measurement and enhance consumer empowerment, thus improving delivery of cancer care," Dr. Haggstrom said. "We propose important approaches that may change how we measure care for cancer patients, tackling such issues as racial disparities, wasteful overuse and patient-centeredness. We also propose applying new models of care to the problems of cancer, including accountable care to better coordinate the care delivered across multiple health care settings, as well as personal health records to deliver and collect medical information to and from patients. These new approaches may well positively disrupt how physicians and patients approach cancer care delivery."