Delivery model for cancer care intelligently redesigned

Trends in cancer care: The power of the e-patient
Trends in cancer care: The power of the e-patient

Recent articles discussed the need to develop both a learning information technology (IT) system for cancer that enables real-time data analysis from cancer patients in a variety of care settings and a national quality-reporting program for cancer care as part of a learning health care system.

These needs embody key recommendations first brought to light in a 1999 Institute of Medicine (IOM) report, which was followed by the September 2013 IOM report on charting a new course for delivering high-quality cancer care.

Such intelligent systems provide patients and clinicians with the information and tools necessary to make well-informed medical decisions, support quality measurement, and improve care. The Affordable Care Act has led to rapid transformation in the nation's health care system, and widespread adoption of efforts that result in meaningful, patient-centric outcomes and address costs of care are critical.

"It's time to pull back the curtain on cancer quality-measurement efforts to date," said author Thomas Feeley, MD, director of The University of Texas MD Anderson's Institute for Cancer Care Innovation in Houston. "Since the IOM recognized the need for a core set of quality measures to improve cancer care nearly 15 years ago, several organizations have made genuine attempts to fill these gaps. But their efforts lacked the breadth magnitude, coordination, and sustainability to transform cancer care across the nation."

In their analyses, Feeley and his colleague, Tracy Spinks, project director of MD Anderson's Clinical Operations, call for federal oversight, ensuring the necessary level of leadership to direct, coordinate, and fund nationwide quality efforts. The authors, who also served as contributors to the most recent IOM report, propose that this model would enforce key tasks for the intelligent redesign of cancer care delivery. Their articles were published in Healthcare: The Journal of Delivery Science and Innovation (2014; doi:10.1016/j.hjdsi.2013.11.003) and the Journal of the American Medical Informatics Association (2014; doi:10.1136/amiajnl-2013-002346).

They have several suggestions to put the patient at the center. The Centers for Medicare and Medicaid Services, the National Quality Forum, and other professional organizations should be enlisted as key partners to align, unify, and accelerate quality-measurement efforts already underway. Quality measures should be expanded to include metrics that are meaningful to providers, payers, and patients, with the highest priority given to those directly tied to outcomes. Health services research and clinical trials should be funded that elicit nontechnical dimensions of quality cancer care and integrate the patient perspective.

Additionally, health care IT systems can be enhanced by partnering with clinicians and the IT industry to collect and report standardized cancer metrics data. This will spur innovation and improvement. An ideal system supports clinic workflow, powerful data analytics, real-time decision-making, care coordination, and patient access.

Furthermore, they advocate establishing a public-reporting procedure that emphasizes transparency and that presents data in a way that guides patients and caregivers in their health care decision-making.

The articles also address how important it is to include the perspective of elderly patients in metric development, as well as ensuring access to institutions that care for vulnerable and underserved populations.

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