Competition no obstacle in a new cancer project created by consortium
A new era of cooperation begins with oncology
Cancer hospitals always are quick to explain that they are different, often pointing to their special commitment to their patients and ability to deal with end-of-life issues. But those differences are rarely accounted for in the benchmarking data they use. The facilities have a keen sense of competition and have, until recently, been unwilling to come together for benchmarking purposes.
But all that changed in 1997 when the Joint Com-mission on Accreditation of Healthcare Organizations started talking about ORYX. Cancer hospital executives knew from experience that comparing data with noncancer hospitals wouldn’t be useful, so a group of them came together and created a National Cancer Database initiative that would allow for subcomparisons within the ORYX system.
Four years later, they are beginning to see the results of their efforts, says Colleen Allen, RN, MBA, CPHQ, director of Clinical Quality and Resource Management at the James Cancer Hospital in Columbus, OH. "Until we started this, it was a real struggle to find appropriate comparisons," she says. "There were few indicators from vendors that measured oncology care."
Representatives from 11 cancer hospitals attended the initial meeting, including MD Anderson in Houston, Fred Hutchinson Cancer Center in Seattle, and Memorial Sloan Kettering Cancer Center in New York City, which hosted the gathering. The group reviewed several benchmarking and data vendors before settling on the Medstat Group of Ann Arbor, MI — and the Comprehensive Cancer Center Consortium for Quality Improvement (C4QI) was born.
By March 1998, eight institutions were discussing what indicators to look at first. Their consensus: surgical hemorrhage for all acute care discharges; length of stay (LOS) for myeloproliferative disease; LOS for respiratory disorders; LOS for skin disorders; and LOS for digestive disorders. Data submissions began in July of that year, and the data were returned from ORYX in 1999. The group had conferences over the course of the next year and produced its first report late in 2000.
The group was committed to comparing clinical quality, sharing best practices, and expanding its network. Now, says Allen, there are 14 cancer centers involved in the process, sharing information in monthly conference calls on issues such as wait time, appointment management techniques, and patient safety initiatives. It has decided upon 12 outcomes measures to focus on, including LOS; mortality; complications for myeloproliferative disease; and respiratory, skin, and digestive disorders.
"The big breakthrough for use [came] as we grew and discussed how we would share information and work with Medstat on ORYX indicators," explains David Snow, RPh, MBA CPHQ, the quality management facilitator at MD Anderson Cancer Center in Houston.
Looking for critical mass of participants
Thus far, five of the 14 members are reporting data, and the rest are on the way, says Snow. But already the group is finding the data useful. "I think it’s because the data aren’t volume driven, but rate driven," says Allen. "We don’t have to rely on the number of patients exhibiting a certain complication, but on the rate of patients as compared to like institutions."
Snow cites data related to mortality in myeloproliferative diseases. (See chart on myeloproliferative diseases, below. All charts in this story are courtesy of the Comprehensive Cancer Center Consortium for Quality Improvement.) "Why is hospital L so different?" he asks. "We look at end-of-life decisions, and we find that this is for inpatient data — for patients who died in the hospital. But in some facilities, hospice is in-house, so their mortality rate is going to be higher. That was part of the answer in this case."
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Looking at complications of care (COC) vs. mortality, Snow continues, "You wonder what makes complications of care go up and mortality go down. (See chart on COC index, below.) When we investigate, we find it is that one group may use hospice and home care, and another group would rather leave them in the hospital. What we have been able to do is identify practice patterns between similar physicians."
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All of the data will have an impact in the way care is provided at MD Anderson, he says. "We suddenly have a new way of comparing our data. We have a way to look at why and how we are different."
Allen agrees that having the data is a giant step forward for cancer centers, with implications for administration as well as clinical care. "One thing we are looking at is how we code complications." In viewing surgical hematoma and hemorrhage, two organizations have higher numbers than the rest. "We are looking together to see how our coding affects this." (See chart on surgical hemorrhage and hematoma, below.)
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There are 37 cancer centers in the country, and membership in the C4QI group is growing. "I don’t know if we will get around to all of them," says Snow. "It would be nice, but what we really want is critical mass. That way anyone who wants to compare themselves to our data can, knowing that it is a statistically valid database of cancer patients only."
Allen thinks the group is near that critical mass. "We have made real progress in the last two or three months, and the word is out. We were just a budding initiative with four or five of us talking to each other. But now we have gained support from CEOs and nurse executives of the [prospective payment system]-exempt cancer hospitals. They recognize that this is something of great value to them."
A web site is under development for the group, and there are discussions pending about what data to examine next. Also on the agenda: standardizing definitions and methodologies and incorporating patient satisfaction data. "We are all competitors," says Snow. "But we have learned that we can share data, allow for confidentiality, define best practices, and still remain competitive."
[For more information, contact:
• David Snow, RPh, MBA CPHQ, Quality Management Facilitator, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. Telephone: (713) 792-8895.
• Colleen Allen, RN, MBA, CPHQ, Director, Clinical Quality and Resource Management, The James Cancer Hospital and Solove Research Institute, 300 W. 10th Ave., Columbus, OH 43210. Telephone: (614) 293 4895.]
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