Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.
Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.
Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.
Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility-level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66).
Limitations Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient’s care to the correct facility.
Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.
Funding Veterans Health Administration Office of Informatics and Analytics.
Morbidity related to cancer and its treatment remains a significant source of human suffering and a national challenge to delivery of high-quality cancer care. Quality care refers to the delivery of state-of-the-art treatments intended to achieve cure or prolong life as well as the supportive processes that address the disease- and treatment-related burdens of living with cancer. These processes span the cancer care continuum from diagnosis to end of life, and include pain-, symptom-, and side effect-management; psychosocial support; communication needs; and support for caregivers. 1-5
A 2006 report from the Agency for Healthcare Research and Quality concluded that “a large number of measures are available for addressing palliative cancer care, but testing them in relevant populations is urgently needed.” 6 Since then, evidence-based standards have been translated into “quality indicators” that may be used to identify outcome targets indicative of quality care, such as patient reports of pain reduction; or, they may specify facility-level care processes associated with these outcomes, such as pain screening, treatment, and follow-up assessment. 1,7-9 Quality indicators can be used as the basis for tools to
measure processes that are critical to ensuring highquality supportive cancer care and identifying specific processes and practice sites that should be targeted for quality improvement efforts. 10,11 Such tools can help characterize care quality for patient populations served by a health care system as a whole, while revealing important variations at individual facilities within the system.
