Quality of care in oncology and its measurement

Research areas: Oncology, HTA-methods & steering instruments

Duration: February - October 2011

External review: Susanne Merkel
Internal review: Claudia Wild
Prepared for: Federal Ministry of Health, Vienna
Duration: Feb. 2011 – Oct. 2011
Language: German
Publication: HTA-Project report No. 049: [Quality of care in oncology and its measurement] - https://eprints.aihta.at/934

Background:
The spectrum of conditions classified under the term cancer poses particular challenges for quality measurement. Multimodal treatment combinations (surgery, chemo-, hormone-, immune-, radiation therapy) for this increasingly chronic illness frequently alternate between in- and outpatient settings. Multiple actors in the healthcare sector need to be monitored over what are often extended periods of time in order to measure quality.

Aims and research questions:
To inform the ongoing development of the Austrian National Cancer Plan, this report addressed the following study questions:

• What are properties of high quality oncological care?
• Which quality indicators for oncological care are available internationally? Which initiatives work on these?
• What are important elements in indicator development for oncological care?
• What are the practical challenges of implementing systems of quality measurement in cancer care?

Methods:
A systematic literature search in databases – reviewed independently by two researchers – was followed by an unsystematic hand-search via Google and on relevant homepages. To identify additional literature experts in the field were contacted.

Results:
The report focuses on ongoing activities and initiatives in the area of quality measurement in cancer care. 22 of these from seven countries are presented in some detail. In addition 17 complete indicator sets are included in the appendix.
Further development efforts are particularly needed for quality indicators that compare subgroups, indicators for less frequent cancers, indicators that take psychosocial elements into account or address quality of life and incorporate patients’ perspectives. The same is true for end-of-life care quality indicators.

Conclusion:
Apart from the obviously required know-how for indicator development and the necessary establishment of an efficient electronic data collection infrastructure, knowledge about and experience with the development of clinical guidelines and patient pathways are crucial for establishing a quality system for cancer care. Data analysis and feed-back skills are required. In order to actually improve quality at the point of delivery of patient care, a sense of ownership for the quality improvement process needs to be fostered among stakeholders.