National survey data could validate rad onc quality indicators

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Benchmarking utilization patterns provides a foundation for assessing the appropriateness of cancer care in the future, according to research published in the July issue of the Journal of the American College of Radiology.

Quality Research in Radiation Oncology (QRRO) embarked on a national process survey to provide benchmark data that will allow radiation oncologists to assess the quality of care in their practice by measuring quality indicators and comparing individual with national practice benchmarks for each disease site in the survey: cancer of the breast, cervix, lung, prostate and stomach. QRRO evolved from the Patterns of Care Study (PCS).

Jean B. Owen, PhD, from the QRRO at the American College of Radiology (ACR) in Philadelphia, and colleagues developed quality indicators on the basis of nationally recognized, evidence-based guidelines such as those of the National Comprehensive Cancer Network, as well as additional emerging quality indicators for processes involving emerging technology. They defined the quality indicators as clinical performance measures.

The investigators reviewed published results of the national survey database for patients treated in 1998 and 1999, and additional analyses conducted to assess data adequacy to measure compliance with these clinical performance measures.

The researchers found that examples of workup quality indicators for breast cancer patients showed that 97 percent underwent diagnostic bilateral mammography, 96 percent underwent pathology reviews, 83 percent underwent the determination of estrogen receptor status, 81 percent underwent the determination of progesterone receptor status and 31 percent underwent the determination of human epidermal growth factor receptor 2 status. Compliance with treatment quality indicators for field recommendations on the basis of nodal findings can be measured, according to the authors.

Of patients with prostate cancer, 90 percent underwent digital rectal examinations, 99 percent underwent prostate-specific antigen tests and 99 percent had their Gleason scores determined, Owen and colleagues found. Compliance with quality indicators on the basis of prognostic group can also be measured.

Although not collected originally for the purpose of measuring quality indicators, the researchers said that the PCS database is a potentially rich data source that can be used to validate these measures. In addition to providing evidence on the usefulness of specific proposed quality indicators and identifying areas of practice needing improvement, this project allows recommendations for the development of additional evidence-based quality indicators.