Evidence-based cancer data system promotes adherence to specific NQF quality measures and ensures patients remain visible in the vast cancer care network
NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE RELEASE
CHICAGO (September 19, 2011): A new tool to promote and facilitate evidence-based cancer care at the local level makes its debut today as the Commission on Cancer (CoC) of the American College of Surgeons (ACS) introduces its Rapid Quality Reporting System (RQRS) to the more than 1,500 hospital cancer programs that it accredits. RQRS is a voluntary web-based data collection and reporting system that is enabled through the National Cancer Data Base (NCDB), a nationwide oncology outcomes database of all CoC-accredited cancer programs in the United States and Puerto Rico. The system launches today with 66 test sites at CoC-accredited programs around the country already using RQRS.
RQRS was primarily developed to assess how well CoC-accredited cancer programs adhere to specific cancer care recommendations called "quality measures" when caring for patients with breast, colon, or rectal cancer. There are six quality performance measures that are monitored, all are defined by the Commission on Cancer and five are endorsed by the National Quality Forum (NQF). Four of these measures are considered to be the standard of care based on clinical trials evidence (accountability measures) and two are considered to be indicators of good clinical care (used for quality improvement or surveillance purposes). The CoC, through its National Cancer Data Base, has the only system available in the United States to apply these quality measures and feed data back to cancer providers caring for the majority of U.S. cancer patients. This system in turn allows them to evaluate and improve the care they provide across all aspects of cancer care.
The "rapid" quality reporting system is just that. The innovative system operates in "real clinical time," thus enabling cancer clinicians to get feedback from NCDB on their submitted cases in real time. Previously such feedback has taken up to two years to be delivered to a cancer patient's interdisciplinary cancer team.
Consequently, RQRS functions as a proactive tool that works to keep patients visible in what can sometimes be a vast cancer care treatment network. RQRS is believed to be the first national system for any disease that tracks care over time, thus ensuring that patients can get the required care they need, when they need it.
"A key issue in cancer care is that people require treatment over a period of time, often administered by a number of different doctors in different specialties, such as surgeons, radiation oncologists, and medical oncologists," said Stephen Edge MD, FACS, Chair of the Commission on Cancer. "Until RQRS, there has been no coordinated way to help track whether people get appropriate care," he said. He further explains that RQRS solves this problem by issuing an "alert" to the cancer program and patient’s doctor "if a point in time is reached whereby the patient should start care, and it is not reported to RQRS." Then the cancer program’s staff can act on that alert by contacting the patient and ensuring the patient doesn’t fall by the wayside. This alert mechanism may assist cancer programs in augmenting the patient navigation standard that is now required for all CoC-accredited programs according to its 2012 patient-centered standards just released in August.
Roswell Park Cancer Institute, Buffalo, NY, where Dr. Edge serves as professor of surgery and oncology, was an RQRS test site and the Institute will continue to use the system as part of its accredited cancer program. Dr. Edge reports that during the testing phase "RQRS showed that we give great care in most cases, but also allowed us to follow up on the few patients who were starting to 'fall through the cracks.' Since we implemented the system, we have had not a single patient in RQRS fall through the cracks-–we have followed through on every cancer patient."
"We were eager to participate in testing this effort," said Nancy Johnson, executive director of the Nancy N. and J.C. Lewis Cancer & Research Pavilion, a National Cancer Institute-designated cancer program accredited by the CoC, at St. Joseph’s/Candler, Savannah, GA.
"We have already seen the RQRS system at work within our cancer program. We serve a 33-county area," she explains. "By following up on alerts for patients whose disease status predictably required additional treatment, we have found some patients from outlying areas who needed assistance, and we were able to contact them. Ultimately, we were able to help those patients continue on their treatment pathways."
The Commission on Cancer anticipates that it will take some time for many cancer registries to readjust their work flow and staffing to accommodate RQRS at their facilities, which is one reason why it is being introduced as a voluntary program. However, after preliminary testing most registry staff reported that RQRS could be implemented and maintained with as little as six hours of extra work per week. St. Joseph’s/Candler implemented RQRS into the current system by assigning a treatment registrar, "who works with the registry, the navigators, and the physician practices to collect the data, and notify the clinical team about making contact with patients, "Ms. Johnson explained.
Looking ahead, in a few years the CoC anticipates a viable use for RQRS for other disease sites, including lung, stomach, and prostate cancers. However, the CoC’s initial priority is to start enrolling as many of its accredited cancer programs in RQRS as soon as possible. This initiative will give all cancer programs a clearer picture of how well they are doing locally with delivering quality cancer care to all patients seen at their accredited programs.
"While the ultimate success of RQRS is helping every cancer program improve the quality of care they provide, RQRS will be considered a smashing success for every single cancer patient that it helps, because it ensures that care is administered properly," Dr. Edge concluded.
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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
The Commission on Cancer is a consortium of 47 professional organizations that establish cancer care standards and monitor quality at hospitals that it accredits. More than 1,500 hospitals in the United States and Puerto Rico are CoC accredited, representing only 30 percent of all institutions but more than 70 percent of all new cancer cases diagnosed annually.
Cory Suzan Petty