Presentation 3: Defining and Measuring Quality Outcomes in Oncology

Dr Newcomer says that he welcomes the transition of oncology from being evaluated in process measures to outcome measures. He says that while quality measures can be quick and messy, these results are used for the purpose of finding gaps and seeing if those gaps can be improved.

“Accuracy for quality improvement measures has to use what I call the ‘hand grenade and horseshoe criteria’; close is good enough,” Dr Newcomer says.

He goes on to explain that the questions and concerns of patients may not be the same as those of providers when delivering care. As well, certain hospital-collected data can serve to supplement provider-patient discussions of treatment outcomes. Patients may choose differently when better informed about certain outcomes of their treatment.

“If we can now look at outcomes and if I can, as a payer, gather data on hundreds, if not thousands, of patients with a specific clinical diagnosis treated with several different regimens, we should be comparing the chemotherapy regimens, not the doctors,” says Dr Newcomer. “If we find a chemotherapy regimen that has much higher toxicity for the same outcome, much higher cost for the same outcome, that belongs in a ‘Mark Fendrick column’ that says you have to pay more to get that drug, or it shouldn’t be covered at all.”

As “hodgepodge” as quality improvements are, they must be integrated into the process of outcomes measurement.

“I don’t think your accreditation makes much difference here. I don’t think those measures are actually going to get patient care better. The kind of work that we’re talking about measuring for quality improvement and having an open dialogue about it is what’s going to get us to where we need to be much, much faster,” states Dr Newcomer.