Lately, an increased focus on quality and patient safety has evolved, and various healthcare organization have developed metrics specifically related to the care of patients with cancer. However, the increase in quality and safety metrics can be overwhelming.

Kristen Fessele, PhD, RN, AOCN®, a postdoctoral fellow at the University of Utah, and Simone Karp, RPh, of CECity, discussed quality metrics and how to choose the most appropriate measures for each institutional program during a session at the 41st Annual Congress in San Antonio, TX.

Karp began the session by noting, “Things are changing so rapidly. Ten years ago we probably wouldn’t even have a session like this.” 

A Health and Medicine Division report indicated that in a decade (1999−2009), U.S. salaries increased by 38%, while healthcare premiums increase by 131%. “This is why we are seeing so many changes at the national level,” Karp noted, in regard to the many federal initiatives being put forth to increase quality of patient care while reducing overall health system costs. In 2009, $2.5 trillion was spent on health care in the United States, and $176 billion of that is related to waste, including unnecessary services, fraud, excessive administrative costs, insufficient delivery, prices hikes, and missed prevention opportunities.

With the new economy in health care moving to quality, Karp noted six broad tactics to reduce costs and improve quality.

  1. Patient safety
  2. Patient and caregiver engagement
  3. Care coordination
  4. Dissemination of best practices
  5. Population and public health
  6. Efficient use of healthcare resources

Fessele went on to discuss choosing specific quality measures that matter for each provider and facility. “There are thousands of measures out there. Many of them may not seem applicable to your facility,” she said, noting some areas of interest for oncology nurses, including patient-centered, nurse-sensitive, quality versus payment focused, support accreditation, and specialty versus cross-cutting. 

When looking for quality measures, Fessele advised the following options: the National Quality Measures Clearinghouse, National Committee for Quality, National Quality Forum, Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services, and specialty organizations, such as ONS and the American Society of Clinical Oncology.

The majority of quality and safety measures are still process-focused as opposed to outcomes measures. Fessele did mention a recent improvement in the American Nurses Credentialing Center’s Magnet Recognition program that updated quality measures to include ambulatory nurse-sensitive requirements.

She then gave some examples of oncology-related quality measures, including

  • Primary care
    • Cancer screening (e.g., mammography)
    • Prevention (e.g., tobacco cessation, sunscreen)
    • Coordination of care (e.g., long-term survivorship)
  • Oncology practice‐focused
    • Diagnostic (e.g., molecular testing for treatment selection)
    • Treatment 
  • Avoidance of unnecessary/outdated care
     
  • Care of cancer symptoms
    • Symptom assessment
    • Symptom management
  • Patient experience
    • Satisfaction with care
    • Patient‐reported outcome (PRO) measures.

Fessele concluded by noting some areas for medical oncology measure development, including pain control, quality of life, shared decision-making, emergency room use, patient experience/PROs, and five-year cure rate.

Karp finished the session by detailing the effort that ONS is making to help members and their organizations. The ONS Oncology Qualified Clinical Data Registry is a dashboard that stores continuous performance measures—both custom and cross-cutting—that are tied directly to an improvement in patient benefits and economic value. It was one of the first to be approved by CMS, and it meets the qualifications for both the Physician Quality Reporting System and Meaningful Use. The platform allows users to not only track their performance, but also compared with peers and colleagues, as well as national benchmarks. The program has multiple avenues for data capture; those with electronic health records can upload them and those who do not can fill out web-based forms. The registry also links to tools and education materials to help users improve their performance measures and allows the data to be shared in order to “spread best practices,” Dr. Karp noted. 

She concluded that there is a 17-year latency between clinical discovery and the widespread us in practice. “This is how we shorten the 17-year gap.”

Fessele, K., & Karp, S. (2016). Defining safety and quality across the cancer care continuum. Session presented at the ONS 41st Annual Congress, San Antonio, TX, April 28, 2015. 

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