RQRS increases compliance rates to NQF quality measures for cancer care

Participation in the Rapid Quality Reporting System (RQRS) considerably increases how well Commission on Cancer (CoC)-accredited cancer programs report adherence to quality measures of breast and colorectal cancer, according to research findings presented November 30 at the American Society of Clinical Oncology Quality of Care Symposium in San Diego, CA.

“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,” noted Erica McNamara, MPH, Lead Study Author and Quality Improvement Information Analyst in the Cancer Programs section of the American College of Surgeons (ACS) Division of Research and Optimal Patient Care. “[The RQRS] is built to provide an extra layer of support in the coordination of that care.”

The RQRS is a Web-based data collection and reporting system that operates in real clinical time using information gathered through the College’s National Cancer Data Base (NCDB), a nationwide oncology repository of cases treated at COC-accredited institutions. The RQRS officially launched in September 2011 with 66 test sites at CoC-accredited cancer centers across the country.

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.
The analysis found that all five compliance rates rose considerably with 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 said.

Importantly, the compliance rates were analyzed across demographic lines. “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, Study Coauthor and NCDB Senior Manager at the 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 may miss out on important treatments waiting for their care to be pieced together by an interdisciplinary team that may work at different locations. The RQRS addresses this issue by putting specialists, surgeons, and patient navigators in contact with one another to share information routinely and quickly through such features as regular monthly reports. Ms. McNamara noted as an example that if patients nearing the end of their treatment period have not started care for a required therapy, 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.

“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 added.

Recognizing the potential value of this program, the Centers for Medicare & Medicaid Services recently contracted with the ACS to implement the RQRS at 11 cancer hospitals across the country to support some of their public reporting activities through Hospital Compare—a website designed to help patients compare the quality of care offered at hospitals.

For more information about the RQRS, go to www.facs.org/cancer/ncdb/rqrs-gettingstarted.pdf.

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