Using NCCN Clinical Practice Guidelines in Oncology to Measure the Quality of Colorectal Cancer Care in the Veterans Health Administration

Restricted access

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: george.l.jackson@duke.edu
  • 1

    Facts about the Department of Veterans Affairs [fact sheet]. Available at: http://www.va.gov/opa/publications/factsheets/fs_department_of_veterans_affairs.pdf. Accessed August 9 2012.

    • Search Google Scholar
    • Export Citation
  • 2

    EdwardsBKWardEKohlerBA. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer2010;116:544573.

    • Search Google Scholar
    • Export Citation
  • 3

    ZulligLLJacksonGLDornRA. Cancer incidence among patients of the U.S. Veterans Affairs Health Care System. Mil Med2012;177:693701.

  • 4

    ChaoHHSchwartzARHershJ. Improving colorectal cancer screening and care in the Veterans Affairs Healthcare system. Clin Colorectal Cancer2009;8:2228.

    • Search Google Scholar
    • Export Citation
  • 5

    JacksonGLPowellAAOrdinDL. Developing and sustaining quality improvement partnerships in the VA: the Colorectal Cancer Care Collaborative. J Gen Intern Med2010;25(Suppl 1):3843.

    • Search Google Scholar
    • Export Citation
  • 6

    KiloCM. Improving care through collaboration. Pediatrics1999;103(1 Suppl E):384393.

  • 7

    AndersonJCRungtusanathamMSchoederRG. A theory of quality management underlying the Deming management method. Acad Manage Rev1994;19:472509.

    • Search Google Scholar
    • Export Citation
  • 8

    BerwickDM. Developing and testing changes in delivery of care. Ann Intern Med1998;128:651656.

  • 9

    EngstromPFArnolettiJPBensonAB3rd. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Version 12008. To view the most recent version of these guidelines visit NCCN. org.

    • Search Google Scholar
    • Export Citation
  • 10

    EngstromPFArnolettiJPBensonAB3rd. NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer. Version 12008. To view the most recent version of these guidelines visit NCCN. org.

    • Search Google Scholar
    • Export Citation
  • 11

    About NCCN. Available at: NCCN.org. Accessed February 19 2013.

  • 12

    CruseHWiniarekMMarshburnJ. Quality and methods of developing practice guidelines. BMC Health Serv Res2002;2:1.

  • 13

    EngstromPFBensonAB3rdCohenA. NCCN Colorectal Cancer Practice Guidelines. The National Comprehensive Cancer Network. Oncology (Williston Park)1996;10(11 Suppl):140175.

    • Search Google Scholar
    • Export Citation
  • 14

    EngstromPFArnolettiJPBensonAB3rd. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Version 22009. To view the most recent version of these guidelines visit NCCN. org.

    • Search Google Scholar
    • Export Citation
  • 15

    EngstromPFArnolettiJPBensonAB3rd. NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer. Version 22009. To view the most recent version of these guidelines visit NCCN. org.

    • Search Google Scholar
    • Export Citation
  • 16

    HershmanDHallMJWangX. Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer2006;107:25812588.

  • 17

    DeschCEMcNiffKKSchneiderEC. American Society of Clinical Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol2008;26:36313637.

    • Search Google Scholar
    • Export Citation
  • 18

    PorterGAInglisKMWoodLAVeugelersPJ. Access to care and satisfaction in colorectal cancer patients. World J Surg2005;29:14441451.

  • 19

    LukasCVMeterkoMMMohrD. Implementation of a clinical innovation: the case of advanced clinic access in the Department of Veterans Affairs. J Ambul Care Manage2008;31:94108.

    • Search Google Scholar
    • Export Citation
  • 20

    American College of Surgeons Commission on Cancer. Facility Oncology Registry Data Standards (FORDS). Chicago, IL: American College of Surgeons; 2003.

    • Search Google Scholar
    • Export Citation
  • 21

    Program Evaluation of Oncology Programs in the Veterans Health Administration Report on Colorectal Cancer: Within VA Analysis. Washington, DC: Department of Veterans Affairs, Office of Policy and Planning; 2009.

    • Search Google Scholar
    • Export Citation
  • 22

    JacksonGLMeltonLDAbbottDH. Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs. J Clin Oncol2010;28:31763181.

    • Search Google Scholar
    • Export Citation
  • 23

    KeatingNLLandrumMBLamontEB. Quality of care for older patients with cancer in the Veterans Health Administration versus the private sector: a cohort study. Ann Intern Med2011;154:727736.

    • Search Google Scholar
    • Export Citation
  • 24

    Demner-FushmanDChapmanWWMcDonaldCJ. What can natural language processing do for clinical decision support?J Biomed Inform2009;42:760772.

    • Search Google Scholar
    • Export Citation
  • 25

    ZulligLLJacksonGLProvenzaleD. Transportation: a vehicle or roadblock to cancer care for va patients with colorectal cancer?Clin Colorectal Cancer2012;11:6065.

    • Search Google Scholar
    • Export Citation
  • 26

    PhelanSMGriffinJMJacksonGL. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology2013;22:6573.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 75 75 19
PDF Downloads 12 12 2
EPUB Downloads 0 0 0