In 1999, the Georgia Cancer Coalition was created. Preventing cancer and detecting existing cancer earlier, improving access to quality cancer care, and saving more lives from cancer were among its major goals.
To monitor the state’s progress in improving cancer care, the Coalition realized the need to provide reliable, complete, and timely data on residents with cancer and to design a program of specific measures. The Coalition began by improving the cancer registries in Georgia. To monitor progress of its program to improve cancer care, they sought the advice of the Institute of Medicine (IOM). The IOM’s response was the study, Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia.
The one-year study was carried out by an eleven-member committee of cancer experts (click here) which included experienced clinicians, epidemiologists, and public health professionals. The report was submitted to the governor and the Georgia Cancer Coalition in 2005. The committee built on the IOM’s preceding efforts in quality of care, considering definitions and concepts on what constituted quality health care and the principles and criteria to be used in selecting quality measures specifically for cancer care. Guided by the selection criteria of the National Quality Forum’s Strategic Framework Board, the committee developed an iterative scoring evaluation, which was applied to evidence-based measures available in the literature.
In all, 52 measures were selected, focusing on adult breast, colorectal, lung, and prostate cancers, since these comprise the majority of cancer cases. This included:
- 10 measures in the domain of preventing cancer
- 5 in early detection of cancer
- 14 in diagnosing cancer
- 23 in treating cancer, including follow-up and palliation
Measures were judged based on their importance, scientific acceptability, and feasibility. They were required to:
- relate to Coalition goals of either preventing cancer and detecting existing cancers earlier or improving access to quality cancer care for all Georgians
- have clear and compelling rationales
- be actionable
- help lead the improvement of cancer care in Georgia
Each measure also took into consideration the source, its relevance to care, available Georgia statistics, an approach to calculating the measure, potential data sources, its limitations and potential benchmark sources. The committee attempted to focus on measures that did not require new systems or heavy resource use. Most measures could be collected from good registry data or other existing systems, but occasional recourse to medical charts or more difficult sources was consider if the information was a priority.
Another aspect crucial to making a significant improvement in cancer care in Georgia is addressing disparities in care. To that end, the committee recommended that the system collect and analyze data pertaining to patients’ experiences to yield insights on how to address racial, ethnic and socioeconomic disparities in cancer care.
The committee further urged the Coalition to remember that the purpose of monitoring quality of care is not only to evaluate progress but to motivate change. They recommended that the monitoring system be transparent and public.
Georgia intends to proceed expeditiously to implement the recommendations of the IOM report. The Georgia system would be the first of its kind and could provide a model for other states to address the quality of cancer care in a comprehensive statewide program.
Jill Eden, Study Director; Roger C. Herdman, Director, National Cancer Policy Board; Elizabeth J.Brown, Research Assistant
Assessing the Quality of Cancer Care:
An Approach to Measurement in Georgia is available for sale from the National Academies Press, 500 Fifth St. NW, Washington, DC 20001; call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area).
Read a brief overview of Assessing the Quality Of Cancer Care: An Approach To Measurement In Georgia.
View or order the full IOM Report.
Information about the Institute of Medicine, visit the IOM home page
See a list of The Committee on Assessing Improvements in Cancer Care in Georgia