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Navigating the Quality Landscape in Oncology: Pitfalls and Lessons Learned

Surabhi Dangi-Garimella, PhD
Ensuring access to appropriate data and then using the information to improve healthcare outcomes remains an ongoing challenge-this was the conclusion drawn by panelists participating at the National Comprehensive Cancer Network’s Oncology Policy Summit on Redefining Quality Measurement in Oncology.
Ensuring access to appropriate data and then using the information to improve healthcare outcomes remains an ongoing challenge—this was the conclusion drawn by panelists participating at the National Comprehensive Cancer Network (NCCN)’s Oncology Policy Summit on Redefining Quality Measurement in Oncology, held September 25 in Washington, DC.

The biggest challenge, the panelists said, was with gathering cutting edge data. “We have limited access to data,” said Andrew York, PharmD, JD, CMS. While CMS has created a registry of what it considers high-quality data, “feasibility is hard, and it’s also hard for us to implement changes.” There are practical and operational challenges.

Ronald Walters, MD, MBA, MHA, MS, The University of Texas MD Anderson Cancer Center, added that the growth of personalized medicine will make the process even more challenging.

“Cross-cutting measures don’t have strong evidence,” said Jason Spangler, MD, MPH, Amgen. Citing the Oncology Care Model (OCM), he said that clinically specific measures provide more information compared with cross-cutting measures, which are usually outcomes measures. According to Mary Lou Smith, JD, MBA, of the Research Advocacy Network, the dearth of a high number of enrollees in adult clinical trials is another issue. “With a 5% adult trial enrollment rale, using real-world evidence to inform drug development is a challenge,” she said.

Physician buy-in, especially when documenting information around things like pain and hospice/palliation is important, according to Jennifer Griggs, MD, MPH, University of Michigan, as is care coordination. “However, it is important to define exactly what needs to be coordinated,” she said.

Spangler highlighted the importance of shared decision making and patient-provider conversation, especially when a patient is receiving precision medicine. “With precision care, patients need to know that quality measurements around their precision treatment may be unique,” he said, explaining the likelihood of a disconnect between standard quality metrics and those used for a patient undergoing precision treatment.

Introducing patient-centricity to the discussion, John Fox, MD, MS, Priority Health, said, “We don’t just have to measure everything, but we do need to understand the accuracy of what we are measuring. We definitely need a quality measure to understand patients’ comprehension of their treatment and disease.”

Matthew Alan Facktor, MD, Geisinger Health, Commission on Cancer, alluded to the fact that most quality metrics in use today are process measures, which he said creates a significant gap in quality measurement. He emphasized the need to pay greater attention to structural measures, such as site of care, and availability of tools to deliver quality care, as well as patient-reported outcomes measures.



 
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