American College of Surgeons Breast & Colorectal Cancer Measures Testing & Reporting Project

The 1999 Institute of Medicine report "Ensuring Quality Cancer Care" noted the lack of information on the quality of cancer care, and recommended the development of better measures and data on the quality of cancer care delivery for use by researchers, consumers, providers, and payers. In response to this report, the NCI developed a partnership with the Agency for Health Care Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) to contract with the National Quality Forum (NQF). NQF was asked to work with measure developers to develop voluntary consensus standards for measuring the quality of cancer care. The NQF develops and implements quality measures in a wide variety of medical conditions, and has recently published a hospital accountability measure set that does not contain any clinical effectiveness measures for cancer.

Two of the first three NQF priority areas for measure development and assessment were in breast and colorectal cancer diagnosis and treatment. The American College of Surgeons (ACS) nominated several specific measures from their Cancer Practice Profile quality improvement program for consideration by the NQF. After rigorous evaluation of their measures specifications and current applications, the NQF recommended several enhancements be made in the measure specifications and re-testing of the quality improvement measure set as an accountability measure set to enable hospital-to-hospital comparison of performance on these measures.

In the current project, NCI has contracted with the American College of Surgeons Commission on Cancer (CoC) to further refine and test the feasibility of using their core performance measure set for breast and colorectal cancer as accountability measures in cancer care delivery. These refinements are based on recommendations made by the technical expert panels and steering committee convened by the NQF for advising their membership on voluntary consensus standards for cancer care quality. The project convened an independent expert panel to advise the College on methods and testing procedures. The College revised measure specifications based on these recommendations and conducted a series of statistical validity checks to evaluate the feasibility of hospital-specific reporting on these measures. The data source is the National Cancer Data Base (NCDB).

ACS completed their initial work on measure refinement and evaluation in September 2006. Final reports on both the breast cancer and colorectal cancer measures were produced in October 2006. In a second phase of the project, ACS developed report formats and tested different approaches for providing feedback to participating CoC hospitals to assess the potential application of each measure for quality improvement and public reporting. The College also developed data collection and reporting tools for hospitals that do not currently participate in CoC-accredited programs. The second phase was completed in the fall of 2007.

This NCI-ACS project has set the foundation for the first nationwide implementation of a set of voluntary consensus standards for cancer diagnosis and treatment performance measures. These standards include tools that allow hospitals to use these data in internal quality improvement initiatives. The CoC implemented the measures as part of reporting requirements for all CoC-accredited hospitals in the fall 2007. The measures and templates provide the basis for hospital-specific reporting on cancer quality of care and pay-for-performance demonstration projects.

NCI and the CoC are working with the NCI Community Cancer Centers Program to engage in a national NCCCP collaborative quality improvement project. The project will test the feasibility of improving compliance rates through prospective data collection, measurement and feedback in a cancer registry environment. This Rapid Quality Reporting System pilot project will include the reporting of 38 items involving the NQF-approved breast and colorectal cancer diagnosis and treatment measures. The goal of the project will be to determine if the NCCCP sites can accelerate greater compliance with the quality of care measures in terms of receipt of therapy and timing of therapy, or appropriate documentation of reasons that therapy was considered but not delivered. The data reporting began in August 2009 and will continue through calendar year 2010.