a From Durham Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, North Carolina; Duke University Medical Center, Division of General Internal Medicine, Durham, North Carolina; University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, North Carolina; Duke University Medical Center, Division of Medical Oncology, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Minneapolis Veterans Affairs Health Care System, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; University of Minnesota Twin Cities, Department of Medicine, Minneapolis, Minnesota; Office of Informatics and Analytics, Veterans Health Administration, Washington, District of Columbia; Duke University Medical Center, Division of Gastroenterology, Durham, North Carolina; VA New England Healthcare System, Bedford, Massachusetts; Boston University, Department of Socio-Medical Sciences and Community Medicine, Boston, Massachusetts.
Clinical practice guidelines can be used to help develop measures of quality of cancer care. This article describes the use of a Cancer Care Quality Measurement System (CCQMS) to monitor these measures for colorectal cancer in the Veterans Health Administration (VHA). The CCQMS assessed practice guideline concordance primarily based on colon (14 indicators) and rectal (11 indicators) cancer care guidelines of the NCCN. Indicators were developed with input from VHA stakeholders with the goal of examining the continuum of diagnosis, neoadjuvant therapy, surgery, adjuvant therapy, and survivorship surveillance and/or end-of-life care. In addition, 9 measures of timeliness of cancer care were developed. The measures/indicators formed the basis of a computerized data abstraction tool that produced reports on quality of care in real-time as data were entered. The tool was developed for a 28-facility learning collaborative, the Colorectal Cancer Care Collaborative (C4), aimed at improving colorectal cancer (CRC) care quality. Data on 1373 incident stage I–IV CRC cases were entered over approximately 18 months and were used to target and monitor quality improvement activities. The primary opportunity for improvement involved surveillance colonoscopy and services in patients after curative-intent treatment. NCCN Clinical Practice Guidelines in Oncology were successfully used to develop a measurement system for a VHA research–operations quality improvement partnership.
Correspondence: George L. Jackson, PhD, MHA, Durham Veterans Affairs Medical Center; HSR&D Service (152); 508 Fulton Street; Durham, NC 27705. E-mail: firstname.lastname@example.org
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