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van Hoeve JC, Verhoeven RHA, Nagengast WB, Oppedijk V, Lynch MG, van Rooijen JM, Veldhuis P, Siesling S, Kouwenhoven EA. Managed Clinical Network for esophageal cancer enables reduction of variation between hospitals trends in treatment strategies, lead time, and 2-year survival. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106-112. [PMID: 35963750 DOI: 10.1016/j.ejso.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite evidence-based guidelines, variation in esophageal cancer care exists in daily practice. Many oncology networks deployed regional agreements to standardize the patient care pathway and reduce unwarranted clinical variation. The aim of this study was to explore the trends in variation of esophageal cancer care between participating hospitals of the Managed Clinical Network (MCN) in the Netherlands. MATERIALS AND METHODS Patients with esophageal cancer diagnosed from 2012 to 2016 were selected from the Netherlands Cancer Registry. Variation on treatment strategies, lead time to start of treatment, and 2-year survival, were calculated and compared between five clusters of hospitals within the network. RESULTS A total of 1763 patients, diagnosed in 17 hospitals, were included. 71% of all patients received treatment with a curative intent, which ranged from 69% to 77% between the clusters of hospitals in 2015-2016. Although variation in treatment modalities between the clusters was observed in 2012-2014, no significant variation existed in 2015-2016, except for patients receiving no treatment at all. The 2-year overall survival of patients receiving treatment with a curative intent did not vary significantly between the clusters of hospitals (range: 56%-63%). Nevertheless, the median lead time before patients started treatment with a curative intent varied between clusters of hospitals in 2015-2016 (range: 34-47 days; p < 0.001). CONCLUSION Limited variation in esophageal cancer treatment between clusters of hospitals in the MCN existed. This study shows that oncology networks can promote standardization of cancer care and reduce variation between hospitals through insight into variation.
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Affiliation(s)
- Jolanda C van Hoeve
- University of Twente, Health Technology and Services Research, Enschede, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Rob H A Verhoeven
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Wouter B Nagengast
- University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Vera Oppedijk
- Radiotherapy Institute Friesland, Leeuwarden, the Netherlands
| | | | | | - Patrick Veldhuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Sabine Siesling
- University of Twente, Health Technology and Services Research, Enschede, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Siegel RD, Garrett-Mayer E, Lipner RS, Kozlik MMP, Vandergrift JL, Crist STS, Chen RC, Chiang AC, Kamal AH. Relationship Between Participation in ASCO's Quality Oncology Practice Initiative Program and American Board of Internal Medicine's Maintenance of Certification Program. JCO Oncol Pract 2022; 18:e1350-e1356. [PMID: 35363501 DOI: 10.1200/op.21.00777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Medical oncologists have a variety of options for demonstrating proficiency in providing high-quality patient care. Perhaps, the best-known opportunity for demonstrating individual expertise and lifelong learning is the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) program. At the practice level, ASCO has offered the Quality Oncology Practice Initiative (QOPI) as a means of optimizing cancer care delivery. In this study, we assess the association between active involvement in MOC on an individual basis and whether that individual's practice is involved with the QOPI program. METHODS We evaluated 13,600 US medical oncologists initially certified by the ABIM and divided them into those initially certified before 1990 (the year in which ABIM started to require periodic recertification), those from 1990 to 2007, and those from 2008 to 2016. It was then determined which of these had let their certificates expire by 2020. These data were then compared with practices that participated in QOPI from 2017 to 2019, resulting in the matching of 97% of physicians. RESULTS Of individuals initially certified before 1990 (and technically with lifelong certification), 22% were in QOPI practices. Among those who did not have lifelong certification, there was an association between QOPI participation and maintenance of ABIM certification. For those initially certified between 1990 and 2007, 35% of oncologists with up-to-date ABIM certification were in QOPI practices, whereas only 11% with expired ABIM certification were QOPI participants (P < .0001). For those in the 2008-2016 category, the numbers were 36% v 16%, respectively (P < .0001). CONCLUSION Our analysis identifies a relationship between participation in these ABIM and ASCO proficiency programs. The reasons for this are likely complex and based on a variety of institutional, professional, monetary, and personal factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Anne C Chiang
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT
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Goyal UD, Riegert K, Davuluri R, Ong S, Yi SK, Dougherty ST, Hsu CC. Prospective Study of Use of Edmonton Symptom Assessment Scale Versus Routine Symptom Management During Weekly Radiation Treatment Visits. JCO Oncol Pract 2020; 16:e1029-e1035. [DOI: 10.1200/jop.19.00465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: During radiotherapy (RT), patient symptoms are evaluated and managed weekly during physician on-treatment visits (OTVs). The Edmonton Symptom Assessment Scale (ESAS) is a 9-symptom validated self-assessment tool for reporting common symptoms in patients with cancer. We hypothesized that implementation and physician review of ESAS during weekly OTVs may result in betterment of symptom severity during RT for certain modifiable domains. METHODS: As an institutional quality improvement project, patients were partitioned into 2 groups: (1) 85 patients completing weekly ESAS (preintervention) but blinded to their providers who gave routine symptom management and (2) 170 completing weekly ESAS (postintervention group) reviewed by providers during weekly OTVs with possible intervention. To determine the independent association with symptom severity of the intervention, multivariate logistic regression was performed. At study conclusion, provider assessments of ESAS utility were also collected. RESULTS: Compared with the preintervention group, stable or improved symptom severity was seen in the postintervention group for pain (70.7% v 85.6%; P = .005) and anxiety (79.3% v 92.9%; P = .002). The postintervention group had decreased association (on multivariate analysis) with worsening severity of pain (OR, 0.13; P < .001), nausea (OR, 0.25; P = .023), loss of appetite (OR, 0.30; P = .024), and anxiety (OR, 0.19; P = .005). Most physicians (87.5%) and nurses (75%) found ESAS review useful in symptom management. CONCLUSION: Incorporation of ESAS for OTVs was associated with stable or improved symptom severity where therapeutic intervention is more readily available, such as counseling, pain medication, anti-emetics, appetite stimulants, and anti-anxiolytics. The incorporation of validated patient-reported symptom-scoring tools may improve provider management.
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Affiliation(s)
- Uma D. Goyal
- Department of Radiation Oncology, University of Arizona, Tucson, AZ
| | - Kristen Riegert
- Department of Radiation Oncology, Providence St Mary Regional Cancer Center, Walla Walla, WA
| | | | - Shawn Ong
- Yale University School of Medicine, New Haven, CT
| | - Sun K. Yi
- Department of Radiation Oncology, University of Arizona, Tucson, AZ
| | | | - Charles C. Hsu
- Department of Radiation Oncology, University of Arizona, Tucson, AZ
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Chiang AC, Lake J, Sinanis N, Brandt D, Kanowitz J, Kidwai W, Kortmansky J, LaSala J, Orell J, Sabbath K, Tara H, Engelking C, Shomsky L, Fradkin M, Adelson K, Uscinski K, Vest K, Lyons C, Lemay A, Lopman A, Fuchs CS, Lilenbaum R. Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction. J Oncol Pract 2019; 14:e823-e833. [PMID: 30537462 DOI: 10.1200/jop.18.00419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. METHODS We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. RESULTS Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. CONCLUSION The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.
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Affiliation(s)
- Anne C Chiang
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jessica Lake
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Naralys Sinanis
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Debra Brandt
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jane Kanowitz
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Wajih Kidwai
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jeremy Kortmansky
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Johanna LaSala
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Jeffrey Orell
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kert Sabbath
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Harold Tara
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Constance Engelking
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Lisa Shomsky
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Monica Fradkin
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kerin Adelson
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kathleen Uscinski
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Kevin Vest
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Catherine Lyons
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Arthur Lemay
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Abe Lopman
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Charles S Fuchs
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
| | - Rogerio Lilenbaum
- Yale New Haven Hospital; Yale School of Medicine; Yale Cancer Center; Smilow Cancer Hospital; and Community Health Educators Group, New Haven, CT
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Clough JD, Strawbridge LM, LeBlanc TW, Hammill BG, Kamal AH. Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer. J Oncol Pract 2017; 12:e933-e943. [PMID: 27531384 DOI: 10.1200/jop.2016.013102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the relationships between hospital use of treating oncology practices and patient outcomes. PATIENTS AND METHODS Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of ≥ 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity. RESULTS Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86). CONCLUSION Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions.
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Affiliation(s)
- Jeffrey D Clough
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Larisa M Strawbridge
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Thomas W LeBlanc
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Bradley G Hammill
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Arif H Kamal
- Duke University School of Medicine, Durham, NC; and Centers for Medicare & Medicaid Services, Baltimore, MD
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Mollica MA, Adjei B, Duffin R, Peters E, Thomas M, Asfeldt T, Castro K. Influencing Quality Reporting: Using the Rapid Quality Reporting System in a Community Network
. Clin J Oncol Nurs 2017; 21:561-566. [PMID: 28945724 DOI: 10.1188/17.cjon.561-566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Value-based cancer care warrants an exploration of ways that nurses can influence quality for patients with cancer, particularly in the community setting, where the majority of patients with cancer are treated.
. OBJECTIVES The purpose is to explore how community cancer centers met and sustained key quality breast cancer care indicators through implementation of the National Cancer Institute Community Cancer Centers Program Rapid Quality Reporting System (RQRS) and patient navigation projects.
. METHODS The authors identified and interviewed staff at three sites that achieved significant increases in concordance with three breast cancer outcome measures. FINDINGS Three main themes emerged through analysis.
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Porter JB, Rosenthal EL, Winget M, Smith AS, Seshadri SB, Vetteth Y, Kiamanesh EF, Badwe A, Advani RH, Buyyounouski MK, Coutre S, Dirbas F, Divi V, Dorigo O, Ganjoo KN, Johnston LJ, Recht LD, Shrager JB, Skinner EC, Swetter SM, Visser BC, Blayney DW. Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center. J Oncol Pract 2017; 13:e673-e682. [PMID: 28727487 DOI: 10.1200/jop.2017.021139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the manual data collection required is resource intensive, and reporting is delayed. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCPs) to identify, measure, and improve quality metrics that were meaningful to the care teams and their patients. METHODS Each CCP physician leader collaborated with the cancer quality team to identify metrics, abiding by established guiding principles. Financial incentive was provided to the CCPs if performance at the end of the study period met predetermined targets. Reports were developed and provided to the CCP physician leaders on a monthly or quarterly basis, for dissemination to their CCP teams. RESULTS A total of 15 distinct quality measures were collected in depth for the first time at this cancer center. Metrics spanned the patient care continuum, from diagnosis through end of life or survivorship care. All metrics improved over the study period, met their targets, and earned a financial incentive for their CCP. CONCLUSION Our quality program had three essential elements that led to its success: (1) engaging physicians in choosing the quality measures and prespecifying goals, (2) using automated extraction methods for rapid and timely feedback on improvement and progress toward achieving goals, and (3) offering a financial team-based incentive if prespecified goals were met.
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Affiliation(s)
| | | | - Marcy Winget
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | | | - Yohan Vetteth
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Amogh Badwe
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Ranjana H Advani
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Steven Coutre
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Frederick Dirbas
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Vasu Divi
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Oliver Dorigo
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Kristen N Ganjoo
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Laura J Johnston
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | | | - Joseph B Shrager
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Eila C Skinner
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Susan M Swetter
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
| | - Brendan C Visser
- Stanford Health Care; and Stanford Cancer Institute, Stanford, CA
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The development and acceptability of symptom management quality improvement reports based on patient-reported data: an overview of methods used in PROSSES. Qual Life Res 2016; 25:2833-2843. [DOI: 10.1007/s11136-016-1305-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Siegel RD. ASCO Quality Care Symposium 2016 Exemplars in Quality and Identifying High-Quality Practice: Delivering Quality in the Community Setting (Bon Secours St Francis Cancer Center). J Oncol Pract 2016; 12:898-901. [PMID: 27302081 DOI: 10.1200/jop.2016.012336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chiang AC. Why the Quality Oncology Practice Initiative Matters: It's Not Just About Cost. Am Soc Clin Oncol Educ Book 2016; 35:e102-e107. [PMID: 27249710 DOI: 10.1200/edbk_160113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The nature and cost of cancer care is evolving, affecting more patients and often involving expensive treatment options. The upward cost trends also coincide with a national landscape of increasing regulatory mandates that may demand improved outcomes and value, but that often require significant up-front investment in infrastructure to achieve safety and quality. Oncology practices participating in the American Society of Clinical Oncology (ASCO) Institute for Quality's Quality Oncology Practice Initiative (QOPI) and the QOPI Certification Program (QCP) continue to grow in number and reflect changing demographics of the provision of cancer care. QOPI and QCP benchmarking can be used to achieve quality improvement and to build collaborative quality communities. These programs may be useful tools for oncology practices to comply with new legislation such as the Medicare Access and CHIP Reauthorization Act (MACRA).
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Affiliation(s)
- Anne C Chiang
- From the Yale University School of Medicine, New Haven, CT
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Holden DJ, Reiter K, O'Brien D, Dalton K. The strategic case for establishing public-private partnerships in cancer care. Health Res Policy Syst 2015; 13:44. [PMID: 26462913 PMCID: PMC4604611 DOI: 10.1186/s12961-015-0031-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND In 2007, the National Cancer Institute (NCI) launched the NCI Community Cancer Centers Program (NCCCP) as a public-private partnership with community hospitals with a goal of advancing cancer care and research. In order to leverage federal dollars in a time of limited resources, matching funds from each participating hospital were required. The purpose of this paper is to examine hospitals' level of and rationale for co-investment in this partnership, and whether there is an association between hospitals' co-investment and achievement of strategic goals. METHODS Analysis using a comparative case study and micro-cost data was conducted as part of a comprehensive evaluation of the NCCCP pilot to determine the level of co-investment made in support of NCI's goals. In-person or telephone interviews with key informants were conducted at 10 participating hospital and system sites during the first and final years of implementation. Micro-cost data were collected annually from each site from 2007 to 2010. Self-reported data from each awardee are presented on patient volume and physician counts, while secondary data are used to examine the local Medicare market share. RESULTS The rationale expressed by interviewees for participation in a public-private partnership with NCI included expectations of increased market share, higher patient volumes, and enhanced opportunities for cancer physician recruitment as a result of affiliation with the NCI. On average, hospitals invested resources into the NCCCP at a level exceeding $3 for every $1 of federal funds. Six sites experienced a statistically significant change in their Medicare market share. Cancer patient volume increased by as much as one-third from Year 1 to Year 3 for eight of the sites. Nine sites reported an increase in key cancer physician recruitment. CONCLUSIONS Demonstrated investments in cancer care and research were associated with increases in cancer patient volume and perhaps in recruitment of key cancer physicians, but not in increased Medicare market share. Although the results reflect a small sample of hospitals, findings suggest that hospital executives believe there to be a strategic case for a public-private partnership as demonstrated through the NCCCP, which leveraged federal funds to support mutual goals for advancing cancer care and research.
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Affiliation(s)
- Debra J Holden
- RTI International, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Kristin Reiter
- Department of Health Policy and Management, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Donna O'Brien
- Strategic Visions in Healthcare, LLC, New York, NY, USA.
| | - Kathleen Dalton
- RTI International, 3040 E Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
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