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Cancer Care Quality Measures
Evidence Reports/Technology Assessments, No. 137
Principal Investigators: Karl Lorenz, MD, MSHS and Joanne Lynn, MD. Reviewers: Sydney Dy, MD, Ronda Hughes, PhD, MHS, RN, Richard A Mularski, MD, MSHS, Lisa R Shugarman, PhD, and Anne M Wilkinson, PhD.
Structured Abstract
Objectives:
To systematically identify quality measures and the evidence for them—to support quality assessment and improvement in the palliative care of patients with cancer in the areas of pain, dyspnea, depression, and advance care planning (ACP), and to identify important gaps in related research.
Data Sources:
MEDLINE®, CINAHL©, and PsycINFO© in English 1995-2005. We also conducted an extensive Internet search of professional organizations seeking guidelines and other grey literature (i.e., not published in peer-reviewed journals) using similar terms and attempted to contact all measure developers.
Review Methods:
We searched using terms for each domain for patients (adults and children) with a cancer diagnosis throughout the continuum of care (e.g., diagnosis to death). Pain and depression searches were limited to cancer, but we searched broadly for dyspnea and ACP, because the evidence base for dyspnea is more limited and experts advised that ACP measures would be generalizable to cancer. Measures were included if they expressed a normative relationship to quality and included a measurable numerator and denominator. Citations and articles were each reviewed/abstracted by two of six palliative care researcher/clinicians who described populations, testing, and attributes for each measure.
Results:
The literature search identified 5,187 titles, of which 4,650 were excluded at abstract review. Of 537 articles, only 25 contained measures: 21 on ACP, 4 on depression, 2 on dyspnea, and 12 on pain. Ten relevant measure sets were identified: ACOVE, QA Tools, Cancer Care Ontario, Cancer Care Nova Scotia, Dana-Farber, Georgia Cancer Coalition, University Health Consortium, NHPCO, VHA, and ASCO. We identified a total of 40 operationalized and 19 non-operationalized measures. The most measures were available for pain (12) and ACP (21), compared with only 4 for depression and 2 for dyspnea. Few of the measures were published, and few had been specifically tested in a cancer population.
Conclusions:
A large number of measures are available for addressing palliative cancer care, but testing them in relevant populations is urgently needed. No measures or indicators were available to evaluate the quality of supportive pediatric cancer care. Basic research is urgently needed to address measurement in populations with impaired self-report. Funding field testing of highest quality measures should be an urgent patient and family-centered priority to meet the needs of patients with cancer.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- Final Task Order Questions
- Overview
- Technical Expert Panel and Approach to the Report
- Analytic Framework
- Processes Relevant to Symptom Care and Advance Care Planning Quality Measurement
- Evidence Sources and Searches
- Title Screening, Article Review, and Selection of Individual Studies
- Summarizing the Evidence for Key Questions
- Peer Review Process
- 3. Results
- 4. Discussion
- Appendixes
- Appendix A. Technical Expert Panel Members and Peer Reviewers
- Appendix B. TEP Worksheet
- Appendix C. Literature Search Strategies
- Appendix D. RAND SCEPC Cancer Quality Measures Project - Measure Developer Contact Form
- Appendix E. Cancer Measure Review Article Screener
- Appendix F1. Quality Measures and Indicators for Supportive Cancer Care: Pain
- Appendix F2. Quality Measures and Indicators for Supportive Cancer Care: Dyspnea
- Appendix F3. Quality Measures and Indicators for Supportive Cancer Care: Depression
- Appendix F4. Quality Measures and Indicators for Supportive Cancer Care: Advanced Care Planning
- Appendix F5. Quality Measures for Cancer Palliation: Measures That Cross All Domains
- Appendix G. Peer Reviewer Comments
- Appendix H. Excluded Studies
- References Cited in the Evidence Report
Southern California Evidence-based Practice Center Direcotrs: Paul G Shekelle, MD, PhD, Sally C Morton, PhD. Medical Editor: Sydne J Newberry, PhD. Programmer/Analyst: Afshin Rastegar, MS. Task Order Coordinator: Cony Rolón, BA. Staff Assistant: Susan Chen, BA.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-003. Prepared by: Southern California Evidence-based Practice Center, RAND, Santa Monica, CA.
Suggested citation:
Lorenz K, Lynn K, Dy S, et al. Cancer Care Quality Measures: Symptoms and End-of-Life Care. Evidence Report/Technology Assessment No. 137. (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-02-003.) AHRQ Publication No. 06-E001. Rockville, MD: Agency for Healthcare Research and Quality. May 2006.
This report is based on research conducted by the Southern California Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-003). The findings and conclusions in this document are those of the author(s), who are responsible for its contents, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
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