American College of Surgeons Commission on Cancer Rapid Quality Reporting System: From quality measurement to quality improvement

More than ever, the federal government, payors, patient organizations, and other stakeholders are requiring health care providers to report quality measures. These data are being used for many purposes, including assisting patients in determining which institutions and physicians will provide their care, crafting a pay-for-performance methodology, and meeting regulatory requirements. So, quite often, measurement data are not applied directly to quality improvement.

Systems like the American College of Surgeons (ACS) Commission on Cancer’s (CoC) Rapid Quality Reporting System (RQRS) not only measure quality, but also assist in immediate quality improvement. These are valuable tools for improving cancer care and should be the focus of future research efforts. Cancer care delivery research is an exciting focus of the Alliance for Clinical Trials in Oncology’s American College of Surgeons Clinical Research Program (ACS-CRP). The CoC is partnering with the ACS-CRP program to examine how initiatives such as RQRS can assist cancer programs in evaluating and improving the processes of cancer care delivery.

The CoC has been the leader in quality reporting in cancer care for many years. Since 2005, the CoC has provided its accredited cancer programs with an annual Cancer Program Practice Profile Report (CP3R). This report provides information on individual cancer program compliance with each of the CoC’s quality measures. The current five National Quality Forum-endorsed measures are process measures that report compliance with the provision of appropriate components of treatment in selected colon and breast cancer patients. The reports, provided to all CoC-accredited programs, allow cancer programs to understand their compliance in relation to comparison groups, such as all CoC-accredited programs in their state, region, or all CoC programs in the U.S.

RQRS monthly alert to cancer program with cases not yet compliant with CoC quality measures

RQRS monthly alert to cancer program with cases not yet compliant with CoC quality measures

Purposes of RQRS

One drawback of the current CP3R is the necessary delay in reporting back results to cancer programs because of the required processing of data. The RQRS was designed to provide cancer programs with expedited “real clinical time” results on compliance with the quality measures. Not only does RQRS provide more immediate feedback, it assists the cancer program in identifying cancer patients who have yet to receive required components of their therapy and allows cancer programs to intervene to provide the missing components. This system provides immediate quality improvement in addition to quality measurement. In many instances, cancer programs have reported that use of the RQRS system has been instrumental in assuring that their cancer patients do not “fall through the cracks.”

Participating RQRS cancer programs are expected to identify and report data on newly diagnosed and treated breast and colon cancer patients and submit the required data to the National Cancer Data Base. Although RQRS currently applies to breast and colon cancer cases only, the Quality Integration Committee of the CoC is in the process of developing and implementing quality measures in many other cancer sites, and, therefore, RQRS will apply to these additional sites as well.

Each month, participating cancer programs receive an e-mail alert of cases that have not yet shown compliance with one of the quality measures (see figure, this page). The alert is color-coded (yellow, orange, red) based on the length of time left to provide the necessary treatment and meet the requirements of the measure. Cancer programs may use the accession number on the alert to identify the patient and determine why the required component of care has not yet been provided and intervene to ensure the patient receives the appropriate treatment.

Currently, use of RQRS is voluntary and is available at no cost to cancer programs. The only requirements for participation are CoC accreditation and that the members of the cancer program agree to participate. The system does involve some training and requires some increased registrar participation beyond the usual abstracting requirements. Currently, more than one-third of CoC-accredited programs have implemented RQRS. Beginning in January 2014, a new CoC standard will provide a commendation to cancer programs that have implemented and are using RQRS.

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