defining safety & quality in cancer care

ANN MEREDITH U. GARCIA, MD, FPCP, DPSMO, MCMMO

Internal Medicine – Medical Oncology

Defining safety & qualityin

CANCER CARE

Cancer patientsdeserve the best care possible,

yet many obstaclesrender timely, efficient, safe, and affordable cancer care

an elusive goal…

The Institute of Medicine’sSIX DIMENSIONS of QUALITY

The KEY FOUNDATION of systems-based healthcare quality

improvementCommittee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.

A HIGH-QUALITYcancer care delivery system

IOM (Institute of Medicine). Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: The National Academies Press; 2013.

Principle 1People with cancer have the right to a system ofuniversal health care. This access should not beprecluded because of preexisting conditions,genetic or other risk factors, or employment status.

National Coalition for Cancer Survivorship:Imperatives for Quality Cancer Care

Principle 2Quality cancer care should be available in a healthcare system whose standards and guidelines aredeveloped in consideration of treating the wholeperson with cancer. Health care plans must regardthe cancer patient as an autonomous individualwho has the right to be involved in decisions abouthis or her care.

Hewitt M, Simone JV, editors. Ensuring Quality Cancer Care. Washington, DC: The National Academy Press; 1999.

Principle 3Standards of cancer care should be driven by thequality of care, not only by the cost of care, andshould include participation in clinical trials andquality-of-life considerations.

National Coalition for Cancer Survivorship:Imperatives for Quality Cancer Care

Principle 4All people diagnosed with cancer should haveaccess to and coverage for services provided by amultidisciplinary team of care providers across thefull continuum of care. Health care plans should beheld accountable for timely referral to appropriatespecialists when symptoms of cancer or itsrecurrence may be present.


Principle 5People with cancer should be provided a range of benefits by all health care plans that include primary and secondary prevention; early detection; initial treatment; supportive therapies to manage pain, nausea, fatigue, and infections; long-term follow-up; psychosocial services; palliative care; hospice care; and bereavement counseling.

National Coalition for Cancer Survivorship: Imperatives for Quality Cancer Care

Principle 6People with histories of cancer have the right to continued medical follow-up with basic standards of care that include the specific needs of long-term survivors.


Principle 7Long-term survivors should have access to specialized follow-up clinics that focus on health promotion, disease prevention, rehabilitation, and identification of physiologic and psychosocial problems. Communication with the primary care physician must be maintained.


Principle 8Systematic long-term follow-up should generate data that contribute to improvements in cancer therapies and decreases in morbidity.



Principle 9The responsibility for appropriate long-term medical care must be shared by cancer survivors, their families, the oncology team, and primary care providers.


Principle 10The provision of psychosocial services must be safeguarded and promoted. Persons diagnosed with cancer should receive psychosocial assessments at critical junctures along the continuum of cancer care to determine the availability of needed support and their ability to seek information and advocate on their own behalf.



Principle 11Psychosocial research is integral to comprehensive cancer care, and as such, psychosocial outcome measures should be included in all future clinical trials. The importance of this research and its application and transfer to oncology care plans should be recognized and encouraged.


Principle 12Cancer survivors, health care providers, and other key constituency groups must work together to increase public awareness; educate consumers, professionals, and public policy makers; develop guidelines and disseminate information; advocate for increased research funding; and articulate for and promote survivors' rights.Hewitt M, Simone JV, editors. Ensuring Quality Cancer Care. Washington, DC: The National Academy Press; 1999.

THREE CENTRAL QUESTIONS


What problems are evident in the quality of cancer care and what steps can be taken to improve care?How can we improve what we know about the quality of cancer care?

What steps can be taken to overcome barriers of access to quality cancer care?

Spinks T, et al. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s 10 Recommendations for Improving the Quality of Cancer Care in America. Cancer. 2012;118:2571-82.

Recommendation 1Ensure that patients undergoing procedures that are technically difficult to perform and have been associated with higher mortality in lower volume settings receive care at facilities with extensive experience.


Recommendation 2Use systematically developed guidelines based on the best available evidence for prevention, diagnosis, treatment, and palliative care.

Recommendation 3Measure and monitor the quality of care using a core set of quality measures.


Recommendation 4Ensure the following elements of quality care for each individual with cancer:1) that recommendations about initial cancer management

are made by experienced professionals;2) an agreed-upon care plan that outlines goals of care;3) access to the full complement of resources necessary

to implement the care plan;4) access to high-quality clinical trials;5) policies to ensure full disclosure of information about

appropriate treatment options;6) a mechanism to coordinate services; and7) psychosocial support services and compassionate care.



Recommendation 5Ensure quality of care at the end of life, in particular, the management of cancer-related pain and timely referral to palliative and hospice care.


Recommendation 6Public and private research sponsors, and various health plans should invest in clinical trials to address questions about cancer care management.


Recommendation 7A cancer data system is needed that can provide quality benchmarks for use by systems of care (such as hospitals, provider groups, and managed care systems).


Recommendation 8Public and private sponsors of cancer care research should support national studies of recently diagnosed individuals with cancer, using information sources with sufficient detail to assess patterns of cancer care and factors associated with the receipt of good care. Research sponsors should also support training for cancer care providers interested in health services research.


Recommendation 9Services for the un- and underinsured should be enhanced to ensure entry to, and equitable treatment within, the cancer care system.


Recommendation 10Studies are needed to find out why specific segments of the population (e.g., members of certain racial or ethnic groups, older patients) do not receive appropriate cancer care. These studies should measure provider and individual knowledge, attitudes, and beliefs, as well as other potential barriers to access to care.

Thank you!

defining safety & quality in cancer care

Healthcare