quality of care steven b. clauser, ph.d. chief, outcomes research branch, nci applied research...
TRANSCRIPT
![Page 1: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/1.jpg)
Quality of Care
Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI
Applied Research Program
Division of Cancer Control and Population Sciences
NCCCP “Kick off” Meeting
June 25, 2007
![Page 2: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/2.jpg)
NCI Cancer Care Delivery and Outcomes Group
• Steven Clauser, PhD (co-chair)• Arnie Potosky, PhD (co-chair) • Ted Trimble, MD, MPH (co-chair) • Tanya Agurs-Collins, PhD• Neeraj Arora, PhD• Rachel Ballard-Barbash, MD, MPH• Martin Brown, PhD• Andrea Denicoff, RN• Brenda Edwards, PhD • Paul Han, MD • Diana Jeffrey, PhD
• Joseph Kelaghan, PhD • Jon Kerner, PhD• Sarah Kobrin, PhD• Lenora Johnson, MPH• Holly Massett, PhD• Helen Meissner, PhD • Cherie Nichols, PhD• Julia Rowland, PhD• Stephen Taplin, MD, MPH• Emmanuel Taylor, PhD• Cynthia Vinson, MA
![Page 3: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/3.jpg)
Quality of Care Relates to Several Other NCCCP Components
InformationTechnologies
Quality of
Care
Survivorshipand
PalliativeCare
Multi-Disciplinary
Practice
Disparities
Clinical Trials
![Page 4: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/4.jpg)
• The degree to which health services for patients and populations
• -increase the likelihood of desired health outcomes,
• Are consistent with current professional knowledge, and
• Provide coordination and continuity of care throughout the entire cancer experience
Knowledge-based
Patient-Centered
Systems-minded
What is quality?
![Page 5: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/5.jpg)
To what extent is NCCCP cancer care
knowledge-based?
Prevention Detection Diagnosis Treatment Survivorship End of Life - Primary - Screening - Imaging - Local - Monitor health - Treatments
- Prognostic - Systemic and HRQOL - Palliation
Biomarkers - Trials - Recurrence - Hospice
- Testing - Second - Biopsy Primary
• Identify evidence-based guidelines• Compare treatment delivered to guidelines• Evaluate degree of guideline adherence
![Page 6: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/6.jpg)
To what extent is NCCCP cancer care patient centered?
• “Global” definition centers around provider-patient relationship and communication—understanding patient as a “whole person”– Global metrics include all outcomes of interest to patient – survival,
satisfaction with care, and health-related quality of life
• Picker Institute defines patient-centered care more broadly:· fast access to reliable health advice· effective treatment delivered by staff you can trust · involvement in decisions and respect for patients' preferences · clear, comprehensible information and support for self-care · physical comfort and a clean, safe environment · empathy and emotional support · involvement of family and friends and support for careers· continuity of care and smooth transitions
![Page 7: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/7.jpg)
Is NCCCP cancer care systems-minded?
Process of Care OUTCOMES
Re
cru
itO
utr
ea
ch
& I
nre
ac
h
Org
an
ize
sc
ree
nin
g
Org
an
ize
F
oll
ow
-up
Cla
rify
Dia
gn
os
tic
E
va
lua
tio
n
Cla
rify
re
ferr
al
pro
ce
ss
a
nd
ed
uc
ati
on
Ide
nti
fy a
nd
ch
ara
cte
rize
p
op
ula
tio
n
Risk Assessment
Diagnosis
Cancer or Precursor Treatment
Detection
Intermediate
Long-term
POTENTIAL for improvement at TRANSITIONS ( ) or DURING TYPES of CARE DELIVERY ( )
Cla
rify
Tre
atm
en
t re
so
urc
es
Cla
rify
su
rviv
ors
hip
re
so
urc
es
an
d s
up
po
rt
Org
an
ize
Sc
ree
nin
g
![Page 8: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/8.jpg)
NCCCP quality of care is affected by multiple levels of influence
B. COMMUNITY Leadership, Advocacy Groups’ expectations, Population affluence, Insurance coverage, Geographic and public resources/access barriers, Market pressures; Care delivery/management practices
A. NATIONAL NCI expectations and leadership, Public Policy/Regulations, Purchaser Requirements/changes, Professional Group Standards/Accreditation
C. PILOT GRANTEE Leadership, Resources, Structure, Procedures, Systems, Culture
OUTCOME
Patient: Health Status Satisfaction Quality of Life System: Efficiency Equity Effectiveness
Information S
ystems
PATIENT (and family)
CHARACTERISTICS
ENCOUNTERS
INTERACTIONS
CONTACTS
PATIENT ADHERENCE
CLINICIAN/TEAM CHARACTERISTICS
Delivery Site: Leadership, Systems, Organization
Information Systems
![Page 9: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/9.jpg)
Strategic Approach
• Changing health care systems is the process of moving from the complex to the obvious in time consuming and expensive steps
• NCCCP proposed interventions therefore need to emphasize “off the shelf” and turn key solutions with high potential yield to both NCI and the pilot sites
• Also, need pilot site champions for buy-in and to move initiatives forward
![Page 10: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/10.jpg)
QoC Workgroup Program Principles
• Assess sites needs for internal program quality improvement – Complements external program focus on health disparities – Complement whenever possible NCCCP quality-related initiatives in
clinical trials and survivorship • Create infrastructure for sustained and ongoing quality
improvement to support clinical and patient-centered performance – Enhanced multi-disciplinary QI teams – Enhanced patient support programs based on patient perspective of
needs – Measurement, intervention, feedback on select initiatives
• Compare results to pilot, NCCCP program, and national program trends
![Page 11: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/11.jpg)
Key Quality of Care Program Components
• Baseline Assessments of Quality Improvement (QI) Resources/Capabilities – Enhance NCCCP infrastructure to support and maintain QI activities – Focus on select opportunities linked to national or NCI initiatives
• QI Initiatives to Improve Evidence-based Care and Patients’ Satisfaction and Experience – Sites select opportunities and improvement goals within broad NCI
framework • Baseline and Follow-up Assessments of both
Process and Outcome improvement – Compare when possible to site baseline, NCCCP program
experience, and similar national programs
![Page 12: Quality of Care Steven B. Clauser, Ph.D. Chief, Outcomes Research Branch, NCI Applied Research Program Division of Cancer Control and Population Sciences](https://reader030.vdocuments.net/reader030/viewer/2022032723/56649d1f5503460f949f2615/html5/thumbnails/12.jpg)
Specific Research Questions
• Have the multi-disciplinary QI teams enhanced performance on systems-based measures?– Referral for adjuvant therapy – Provision of treatment summaries to patients
• Have the quality improvement initiatives increased adherence to evidence-based practice? – Is there consistent improvement across sites? – How does their improvement in clinical care compare to
similar national providers or programs?• Are tailored patient education/support programs
associated with improved patient experience and quality of life?