More questions about measuring the quality of cancer care

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Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, blogs about the question, “Can You Really Measure The Quality Of Cancer Care?

Dr. Len concludes:

“…emphasizing that just because someone says one place is better than another, or one doctor is better than another it is important to keep in mind what information stands behind those statements, and how much transparency there is in the methods and the meaning of what they say. If “quality” it is based on lower costs alone, then that frequently is a non-starter since spending more or less money is not necessarily associated with “quality outcomes.”

Ultimately-in my personal opinion–it is spending money appropriately and wisely that is the key to success in cancer treatment. How we measure that accurately and consistently continues to be a significant problem. The good news-as mentioned above-is many of us are aware of that and are trying to do something about it.

We can’t let perfection be the enemy of the good, but as I have maintained for years, it would be terrific if the medical profession stood up and took charge of this issue, offered transparency into what they do and how they do it, and accept that we have a responsibility to our patients to hold ourselves accountable in some reasonable way to offer the assurances the care we provide our patients meets some fundamental measure of quality care. I believe our patients are entitled to no less. We need to measure and demonstrate our commitment to our mission and our patients’ expectations. Just saying we give quality medical care does not make it so.

In the meantime, we will have to settle for whatever quality measures someone offers-even if they aren’t necessarily the quality measures that really define the quality of care we offer or receive. A little transparency into the process would go a long way in providing insight into the accuracy of the data and the assumptions that are made based on that data.

Just saying you measure quality cancer care does not necessarily make it so.”

He’s reacting to one of my blog posts from last week that was based on a commentary by former US Senator David Durenberger that was based on a story by Jeremy Olson of the St. Paul Pioneer Press.

Nice communication chain of events; let’s keep the discussion going.

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Gregory D. Pawelski

July 14, 2010 at 9:25 am

I’ve been thinking about this thread after reading the JAMA article on “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues.” I’ve always thought about the “quality of cancer care” my wife received at our local community hospital.
Her cancer treatment varied tremedously depending on which hospital she attended and the type of treatments given at our local community were the worse and were responsible for her depressed quality of life and her demise.
I did a masterful job of documenting how the passage of time and the complexity of medical care can be instrumental in muddying the waters when trying to get attention focused on both individual lapses in thoroughness, maybe ethics and systemic breakdowns. There was the response that the issue is too complex and maybe politically unpleasant to have the medical board address it or similar circumstances.
It would have been important to know if the doctors and the hospital system involved in my wife’s cancer care felt there was truly a difference of medical opinion, what was their rational for their treatment, actions and decisions were and how they view the apparent breakdowns in work up/follow through/obligation to give thorough information to patient’s risk/benefit discussions and what they will do to improve the situation.
This is an item that takes real time and qualified investigators should be a must. Is there a workable solution? I think a lot people see the problem, it is trying to figure out how to unravel the mess and fix it that eludes us. Oh yea! It all fell on deaf ears!
The quality of life must be considered as a major decision point in cancer care. That element, so long missing in most clinics, hopefully would be brought to the fore especially in the many cancer clinical trials. I hope that quality of life would become a major outcome issue for all involved in the treatment of patients with cancer. I will continue to be an advocate for my loved ones and help others in their own journeys with cancer.