Portfolio of physician-led measures nets better quality of care

March 16, 2017|Oncology Practice

AT THE QUALITY CARE SYMPOSIUM

ORLANDO – A multifaceted portfolio of physician-led measures with feedback and financial incentives can dramatically improve the quality of care provided at cancer centers, suggests the experience of Stanford (Calif.) Health Care.

Physician leaders of 13 disease-specific cancer care programs (CCPs) identified measures of care that were meaningful to their team and patients, spanning the spectrum from new diagnosis through end of life and survivorship care. Quality and analytics teams developed 16 corresponding metrics and performance reports used for feedback. Programs were also given a financial incentive to meet jointly set targets.

After a year, the CCPs had improved on 12 of the metrics and maintained high baseline levels of performance on the other 4 metrics, investigators reported at a symposium on quality care sponsored by the American Society of Clinical Oncology. For example, they got better at entering staging information in a dedicated field in the electronic health record (+50% absolute increase), recording hand and foot pain (+34%), performing hepatitis B testing before rituximab use (+17%), and referring patients with ovarian cancer for genetic counseling (+43%).

“This [initiative] was quite resource intensive for the modest number of patients’ lives covered in our measurements,” commented lead investigator Julie Bryar Porter, MSc, administrative director of the Blood and Marrow Transplant Program and the Cancer Quality Program at Stanford Health Care. “However, it was encouraging that all metrics maintained their strong results or improved performance over time to meet their target.”

“The main drivers, I would argue, besides the Hawthorne effect, were a high level of physician engagement in the selection, management, and improvement of the metrics, and these metrics excited the care teams, which also provided some motivation,” she said. “We provided real-time, high-quality feedback of performance. And last but probably not least was a financial incentive for the CCP as a team, not part of any individual compensation.”

The investigators plan to continue measuring the metrics, to expand them to other sites in their network, and to add new metrics that are common across the programs to minimize measurement burden, according to Ms. Porter. “We also plan to build cohorts for value-based care and unplanned care like ED visits and unplanned admissions. Finally, we want to keep momentum going and capitalize upon a provider engagement in value measurement and improvement,” she said.

“Based on this work and prior abstracts, … there are many validated metrics to be used. So, to choose those metrics and to choose them through local leadership support, most importantly, engaging frontline staff and having their buy-in of the measures that you are collecting are important,” commented invited discussant Jessica A. Zerillo, MD, MPH, of the Beth Israel Deaconess Medical Center in Boston. “And this can include using incentives that drive such stakeholders, whether they be financial or simply pride with public reporting.”

To take this effort forward, certain issues will need to be addressed, she maintained. First, “how do we sustain data collection and change with the fewer resources that continue to be available to us? How do we integrate quality measurement into overall system metrics so that we can demonstrate to our administrative colleagues that the work that we do in quality has an importance at the system level? And lastly, how do we implement patient-reported and long-term outcomes to enhance these measures?”

Study details

“In the summer of 2015, we were starting to feel a lot of pressure to prepare for evolving reimbursement models,” Ms. Porter said, explaining the initiative’s genesis. “Mainly, how do we define our value, and how can we measure and improve on that value of the care we deliver? One answer, of course, is to measure and reduce unnecessary variation. And we knew, to be successful, we had to increase our physician engagement and leadership in the selection and improvement of our metrics.”