Quality Assessment in the USA: How the Patterns of Care Study Has Made a Difference

Abstract

Improving the quality and accessibility of radiation care in the United States has been the primary objective of the Patterns of Care Study (PCS) since its inception. While patient care has two components, technical and interpersonal, the PCS has only studied the quality of technical care. Such assessments of technical quality of radiation oncology, which are representative of the United States as a whole, virtually do not exist outside those of the PCS. The methodology used by the PCS to assess quality in radiation oncology is based on an examination of structure, process, and outcome. Structural elements identified by the PCS to be associated with inferior quality include the use of a Cobalt 60 unit with surface-to-skin distance (SSD) </=80 cm, definitive treatment without the use of a simulator, and facilities with a part-time radiation oncology practitioner (usually a general radiologist) as chief. Process and outcome surveys conducted by the PCS have resulted in major findings related to quality of acre in prostate cancer, cervical cancer, Hodgkin's disease, and seminoma, which findings are reviewed elsewhere in this issue. The results of the PCS process and outcome findings related to quality of care for larynx, tonsil, anterior two thirds of the tongue and the floor to mouth, breast, endometrium, rectum, and palliation of bone and brain metastases and locally advanced lung cancer are reviewed here. The PCS has provided useful information on quality that has aided in standards development and in radiation oncology practice accreditation. Currently, the PCS is examining the patterns of care of minorities and the penetration of the results of clinical trials into national practice and is collaborating with the American College of Surgeons in studying the treatment of early-stage breast cancer. It is crucial that the PCS, rather than the government or health maintenance organizations (HMOs), be a leader in the evaluation of quality as the PCS represents a well-organized, experienced effort to provide professional guidelines for radiation oncology based on well-established methodology and unencumbered by political or shareholder concerns.