Kelli K. Olsen, MS, CTR City of Hope National Medical Center Duarte, CA

 Allows administrators to determine if they are truly meeting the goals of the organization.  Are you fulfilling your “mission”?

 “Quality improvement (QI) focuses on doing the right things and doing the right things right.” (Longest Jr, 2008, pg. 301)  Avedias Donabedian established a way to best to measure quality using three types of measures: ◦ Structural Measures ◦ Process Measures ◦ Outcome Measures

“Pay-for-performance” is an umbrella term for initiatives aimed at improving the quality, efficiency, and overall value of health care. These arrangements provide financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients. (“Health Policy Brief: Pay-for- Performance,” Health Affairs, October 11, 2012.)

 Accountability Measures have been a part of the Joint Commission Accreditation for many years, with financial implications beginning in ◦ SIP and SCIP measures  The National Quality Forum endorsed Oncology specific performance measures in ◦ Best source for data appeared to be the Cancer Registry.

 Three breast and three colorectal measures  Performance rates generated starting with 2008 cases using NCDB data  Became part of the Standards for Commission on Cancer Accreditation beginning in 2012

 Ability to identify cases faster  Abstracting timeline  Accurate documentation of eligibility criteria  Methods to track cases

 Case Identification ◦ Enrollment in RQRS ◦ Department of Information Sciences (DIS) development of Patient List Analytic Report for specific sites ◦ Diagnosis Harmonization

 City of Hope enrolled and began transmitting cases in January ◦ Timely review of data with alerts updated (data usually updated within 24 to 48 hours) ◦ Identifies which cases fall into the proper metric ◦ Many tools that assist in tracking performance rates in real time and identifying problems early on

Pathology Reports --Select past week pathology reports from that have “Breast” and “Colon” part descriptions (sections of pathology report) Synoptic Reports --Select past week breast and colon synoptic reports --Transpose and codify important abstracting fields from such as ER & PR status, TNM Stage Complaints at Visits --Select patients with past week visit from health issues table with visit complaint text “BREAS”, “BRAS”, “BRES”, “COLON”, “RECTAL” Billing Diagnoses --Select patients with past week visit that have breast and colon cancer specific ICD9 codes from the patient billing diagnoses table Combine in an Excel Report --Create unique record per patient with most recent combined information from four sources and list patient’s age and gender -- Automated to cancer registrar every Monday

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 Date of diagnosis is crucial aspect of performance measurement. Must identify cases immediately and enter pertinent information at time of accessioning cases.  Asked Registrars to begin abstracting Breast and Colorectal cases concurrently (started this process when COH enrolled in RQRS in January 2013)  The Analytics group in DIS has also began to “crack the code” of synoptic reports, in order to pull information out more quickly for the Registrars to use

 Multiple levels of quality control on the Cancer Registry data ◦ The Cancer Registry Control Plan (Std. 1.6, which reviews a random selection of all analytic cases) ◦ By using the RQRS system, cases are reviewed to ensure that the proper cases are being captured ◦ The Synoptic Reports project includes a comparison between the synoptic reports and the information in CNExT to check for accuracy  Physician Forms ◦ Five forms were created by the Cancer Registry Administrator to track therapy for cases that are eligible for one of the quality measures. If there is no indication that the patient will receive therapy at COH, a form is sent to the proper physician and the responses are documented in a grid and in the patient chart.

 RQRS, CP3R and the Patient List Analytic Report ◦ Excel spreadsheets are downloaded from RQRS and CP3R to monitor cases. ◦ Notes are made on the Patient List Analytic Report to track possible cases. ◦ Abstractors follow each case for six months.  For each case that is non-compliant, the reasons are documented on one of the above lists and in CNExT

 Prospective Payment System-Exempt Cancer Hospitals Quality Reporting Program (PCHQR)  MAC  ACT  HT  Data sent on 11/15/13 to Centers for Medicare & Medicaid Services (CMS) with numbers on the breast and colon cancer chemotherapy measures for Quarter 1 of 2013 by the NCDB. Data for Quarter 2 was sent in February of 2014.

Cancer Registry data now affects reimbursement rates!

 Information Age ◦ CMS patients can view performance rates online, but data may not be represented properly (low n, no confidence intervals, no place to document justified reasons for delay in care, etc). ◦ Potential increase in health care costs when patients want to go to higher-quality insurers and providers, who may in turn increase prices  Third-Party Payer System ◦ “American medical consumers will always demand the best, and they will always expect it to be paid for with somebody else’s money.” (Kleinke, 2001, pg. 159)

 Communication between healthcare providers ◦ Mutual understanding of importance of information gathering (sharing information) ◦ Chart documentation ◦ Follow-up issues  Physician Education ◦ “My patients are sicker”, “My patients are complicated”.  Insurance ◦ Dictates where patient can receive care ◦ Creates delays in receiving treatment

 More quality measures are coming!  Public Reporting will not be limited to PPS-exempt Cancer Hospitals alone

 Embrace our new roles as cancer data experts. ◦ Know the evidence-based guidelines ◦ Communicate with other departments ◦ Educate physicians ◦ Manage deadlines  Familiarize yourself with the quality department ◦ Become best friends with someone in your quality department ◦ Have an understanding of non-oncology quality measures  Speak out! ◦ Communicate with administrators at your hospital, the State registries and the Commission on Cancer.