INTRODUCTION: Delivery of high-quality cancer care improves oncologic outcomes, including survival and quality of life. The VA National Radiation Oncology (NROP) established the VA Radiation Oncology Quality Surveillance Program (VAROQS) which has developed clinical quality measures (QM) as a measure of quality indices in radiation oncology. We sought to measure quality in community care, assess barriers to data capture, and develop solutions to ensure long term sustainability of continuous quality improvement for veterans that receive dual care, both within the VA and in non-VA community care (NVCC).
METHODS: From 2016-2018, the VA-ROQS project randomly selected three Veterans Integrated Service Networks (VISNs) for quality analysis using established QM for prostate cancer, specifically, 6, 16, and 22. NROP manually abstracted data for QM treated in NVCC QMs, which was compared to the performance of the VA QM in the same VISN as well as for all VISNs in the VA.
RESULTS: Out of the 723 NVCC cases that were examined, none were fully evaluable for all 25 Prostate quality metrics. QM was able to be assessed in only 28% of NVCC patients (n=208) reviewed. Only 12/25 (48%) of all Prostate QM were able to be compared between VA and NVCC. Out of the 12 available Prostate QM, 9 were performance, 2 were surveillance, while 1 was an aspirational measure. The overall > 75% pass rate of all the expected performance QM measures for the VA was 13/14 (92%). For NVCC, of the available expected QM for comparison, 8 of which were high potential impact, only 1/9 (11%) QM received a >75% pass rate in all three NVCC VISNs. When examining the 8 high potential impact QM, the VA had a 100% pass rate.
CONCLUSIONS: There are challenges to obtaining data to perform QM assessment from community care. For cases where QM performance could be assessed, VA care outperformed non-VA care. VA-ROQS program is an ongoing quality improvement initiative and in order to ensure that quality is comprehensively collected for NVCC, we propose a web-based portal that will enable providers to directly upload anonymized treatment information and the DICOM treatment plan.