American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Rapid Quality Reporting System Increases Compliance Rates

“Real time” Web-based National Cancer Data Base program helps ensure breast and colon cancer patients get high quality care over the entire course of their treatment

NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE RELEASE

CHICAGO (December 3, 2012): The Rapid Quality Reporting System (RQRS)—a Web-based data collection and reporting system that operates in real clinical time—considerably increases how well Commission on Cancer-accredited cancer programs report adherence to specific cancer care recommendations called “quality measures” when caring for patients with breast and colorectal cancer. These new research findings were presented Friday, November 30, at the American Society of Clinical Oncology (ASCO) Quality of Care Symposium in San Diego.

“Cancer care is unique in that it requires extensive coordination with providers across disciplines to ensure patients receive all of their treatments. Patients are not only getting surgical treatment but also chemotherapy, radiation, and possibly hormone therapy,” according to Erica McNamara, MPH, lead study author and quality improvement analyst at the American College of Surgeons (ACS). “Our system is built to provide an extra layer of support in the coordination of that care.”

RQRS was developed by the Commission on Cancer (CoC) of the American College of Surgeons. The system is enabled through the National Cancer Data Base (NCDB), a nationwide oncology database of all CoC-accredited cancer programs in the United States and Puerto Rico. In September 2011, RQRS officially launched with 66 test sites at CoC-accredited cancer centers across the country already using the program.

Study researchers examined data from 64,129 breast and colorectal cancer cases treated between 2006 and 2010 at 64 RQRS-participating cancer programs nationwide. They assessed how well the cancer programs adhered to five National Quality Forum (NQF)-endorsed quality performance measures before and after RQRS participation. These measures for breast and colorectal cancer define what is known as the standard of care.

The analysis found that all five compliance rates rose considerably after RQRS participation—ranging from an 18 percent increase for adjuvant chemotherapy for stage III colorectal cancer to a 38 percent increase for hormone therapy in AJCC T1cN0M0, or stage II or III hormone receptor positive breast cancer. “We expected to see performance increases, but these results were higher than we initially expected,” Ms. McNamara reported.

Importantly, the compliance rates were analyzed across demographic characteristics. “In the baseline data we see apparent differences in compliance rates for some of these standards of care across age groups, race, and insurance coverage categories,” said Andrew Stewart, MA, study coauthor and NCDB senior manager at ACS. “But the results from this analysis suggest that those differences may actually have been more of a reflection of incomplete data and information in the registries than a reflection of differences in care delivery to subpopulations of patients.”

Still, given the complexity of the cancer care system, patients can possibly miss out on important treatments waiting for their care to be pieced together by an interdisciplinary team that may not work together in one location. RQRS addresses this issue by putting specialists, surgeons and patient navigators all in communication with one another to share information routinely and quickly through features such as regular monthly reports. As an example, Ms. McNamara noted, that if a patient nearing the end of his/her treatment period has not started care for a required therapy, then an automatic “red alert” is sent from the NCDB to the cancer program team.

We know that many cancer treatments take longer than six months to administer, so by tracking patients in real clinical time, RQRS not only prompts participating programs to follow-up on patient care throughout the entire treatment period, it also feeds back performance rates and comparisons based on current patients and clinical practice, not two- or three-year-old data,” Ms. McNamara explained.

The ultimate beneficiaries, of course, are the patients. “We estimate that somewhere between 30 and 40 percent of cancer centers participating in RQRS are catching patients with some regularity within their delivery systems,” Mr. Stewart said. And recently, the Centers for Medicare and Medicaid Services (CMS) has contracted with the ACS to implement this program at 11 cancer hospitals across the country to support some of their public reporting activities through Hospital Compare, a website created by the Federal government to help people find hospitals and compare the quality of their care. “The real time feedback mechanism of this system has the capacity to provide very current performance rates for hospitals that treat cancer patients.”

Study coauthors include James Banasiak, Bryan Palis, E.Greer Gay, RN, PhD, and Stephen Edge MD, FACS.

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About the Commission on Cancer 
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.

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 to improve the quality of care for 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, visithttp://www.facs.org.

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