The Veterans Health Administration (VHA) is the largest provider of cancer care in the United States. With approximately 5.5 million patients receiving care under the auspices of 153 medical centers in 2008, the VHA has the largest fully integrated delivery system in the country.1 The system treats approximately 3% of cancer cases in the United States (>43,000 in 2005). As in the rest of the country,2 colorectal cancer (CRC) is the third most common cancer in the VHA.3 More than 4600 new cases of CRC were entered into the Veterans Affairs (VA) Central Cancer Registry in 2005 (11% of VHA cancer cases).
Recognizing the need to reduce the time from positive screening to diagnosis and enhance the use of guideline-concordant care, the VHA began the Colorectal Cancer Care Collaborative (C4) quality improvement program in 2005. Between February 2007 and April 2008, C4 conducted the Colorectal Cancer Treatment Improvement Collaborative project. As part of this quality improvement effort, the Cancer Care Quality Measurement System (CCQMS) was developed to collect data on cancer care. The CCQMS produces reports on the degree of guideline-concordant care based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and on the timeliness of CRC care.4,5 This measurement tool was developed to evaluate the continuum of CRC care, from diagnosis through treatment and surveillance.
Although the existence of this tool was previously noted as part of summaries of the C4 initiative,4,5 the purpose of this article is to describe the development of specific quality indicators and the CCQMS computerized tool, and use of the CCQMS among the 28 facilities participating in the quality improvement collaborative.
This article represents the work of 28 VA Medical Centers that participated in the VA Colorectal Cancer Care Treatment Improvement Collaborative. The authors wish to thank the abstractors and quality improvement team members who collected the data reported here. In addition, they thank Radhika Khwaja, MD, for providing important clinical input into the development of CCQMS quality indicators. Bryan Paynter, formerly of the Durham VAMC HSR&D Center of Excellence, served as the lead computer programmer for the development of the CCQMS. Other individuals involved in the development of the CCQMS at the Durham VAMC HSR&D Center of Excellence include Catherine Caprio, RN; Melissa Garrett, MD; Natia S. Hamilton, MA; Mike Harrelson; Katie Mitchell, RN; and Christopher B. Newlin, MPH. Preliminary results were presented at the Association of VA Hematology and Oncology Annual Meeting on September 12, 2008 in Nashville, Tennessee.
This study was supported by the Veterans Affairs Health Services Research & Development Service (VA HSR&D grant CRT 05-338) and National Cancer Institute (NCI grants YI-PC-6039-01 and V246S-00054). Dr. Jackson was supported by a Merit Review Entry Program (MREP) award from the Department of Veterans Affairs HSR&D Service (VA HSR&D grant MRP 05-312). Ms. Zullig is supported by funding from the National Cancer Institute (5R25CA116339). During part of this work, Dr. Zafar was supported by a National Research Service Award-Agency for Healthcare Research and Quality Post-Doctoral Fellowship (institutional training grant to Duke University T32HS000079). During part of this work, Dr. Powell was supported by a Veterans Affairs Health Services Research & Development Career Development Award (VA HSR&D CDA 08-024VH). Dr. Gellad was funded in part by a National Research Service Award-National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) institutional training grant (T32 DK007568-17 to Duke University). Dr. Provenzale was funded in part by a K-24 career development award from NIDDK (5 K24 DK002926).
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