Implementation of a performance improvement initiative in colorectal cancer care

Abstract

Purpose: In the United States, colorectal cancer (CRC) is the third leading cause of cancer after breast and prostate cancer. Numerous improvement programs have been implemented to increase CRC screening rates, but few have focused on improving the care and management of patients with a diagnosis of this malignancy. As national medical organizations focus on quality of care, efforts are necessary to provide clinicians the opportunity for self-assessment and methods for practice improvement. With this goal in mind, a national continuing medical education-certified performance improvement initiative was conceived.

Methods: THE INITIATIVE CONSISTED OF THREE STAGES: First, participants self-assessed their performance of predetermined topic measures through a review of patient charts. The topic areas included patient safety and supportive care, evidence-based surveillance, and evidenced-based treatment and were derived from current guidelines and other successful quality-improvement initiatives. Second, an actionable plan for practice improvement was developed in at least one of the three topic areas. Third, after a period of self-improvement, participants reassessed their performance of the same topic measures to determine tangible changes in patient care.

Results: A total of 540 patient charts were reviewed by 27 clinicians. Notable results showed large gains in areas of supportive care, such as quantitative pain assessments and emotional well-being evaluations, which traditionally have been a minor focus of other quality-improvement initiatives. Participants also showed tangible improvements in the performance of leading measures of quality care.

Conclusion: These findings support the need for continued efforts toward performance improvement in both established and emerging areas of CRC patient care.

Figure 1.

Quality measures with significant improvements. (A) Patient safety and supportive care measures: inclusion of surgical pathology report in the patient chart, documented TNM staging information, documented quantified pain assessment, and documented status of emotional well-being. (B) Evidence-based surveillance measures: performance of carcinoembryonic antigen (CEA) blood test at least once before surgery or chemotherapy, performance of CEA blood test at least once 6 months after surgery or chemotherapy, inclusion of number of evaluated lymph nodes in staging considerations, performance and/or order of annual chest and abdomen computed tomography (CT) scans after primary treatment, and performance and/or order of colonoscopy 3 years after primary treatment. (C) Evidence-based treatment measures: documented KRAS status for patients with metastatic colorectal cancer (CRC) and documentation of wild-type status in patients with metastatic CRC receiving cetuximab (CTX) and/or panitumumab (INN).