https://doi.org/10.6004/jnccn.2020.7536
Authors:
D'Amico, TA, Bandini, L, Balch, A, Benson III, AI, Edge, SB, Fitzgerald, L, Green, RJ, Koh, W, Kolodziej, MA, Kumar, S, Meropol, NJ, Mohler, JL, Pfister, D, Walters, RS, Carlson, RW
Background
The modern era of quality measurement and reporting in healthcare began in the 1980s when The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began the systematic evaluation of hospitals. Until the 1990s, cancer care quality was addressed primarily through setting standards for organizational structure through JCAHO and the American College of Surgeons (ACS) Commission on Cancer (CoC) accreditation programs.1 In 1999, the Institute of Medicine (IOM) established the currently accepted framework for quality measurement in oncology, in part based on the structure, process, and outcome model for assessment of healthcare quality defined in the 1960s by Avedis Donabedian.2 Shortly thereafter, the National Quality Forum (NQF) initiated a formal multistakeholder process for identification and validation of quality measures in oncology.3
The recent focus on value in cancer care and the establishment of alternative payment models has renewed interest in the development of a more standardized, contemporary, clinically relevant, easily implemented, and broadly applicable set of quality and outcome measures. The Centers for Medicare & Medicaid Services (CMS) has solicited recommendations for quality measures to include within programs such as the Merit-based Incentive Payment System (MIPS) Value Pathways, the next step in the MIPS program,4 and the new Oncology Care First (OCF) Model.5 Commercial payers have shown equal interest in determining which existing metrics are of high value, and where gaps in good measures exist.6
Most measures to date focus on key processes of care that are evidence-based and intended to improve outcomes. Maintaining a set of relevant high-impact quality measures has proved challenging due to many factors. Rapid innovation in oncology practice, including national changes to coverage reimbursement models, advancements in information technology, and the introduction of practice-changing treatments, have outpaced the historically slow measure development process. Additionally, measures are difficult to evaluate in randomized clinical trials, and therefore many measures rely on best practices based on historical consensus. As a result, many of the leading quality measurement programs have begun to reevaluate their strategies for measuring high-quality cancer care within and across healthcare systems, with the goal of identifying appropriate measures that are feasible, offer the opportunity to document quality improvement, and can be extracted using available and reliable data for ease of evaluation and reporting.7,8
NCCN established the NCCN Quality and Outcomes Committee (the Committee), consisting of experts from NCCN Member Institutions and other stakeholders, including payers and patient advocacy, community oncology, and health information technology representatives, to review the existing quality landscape and identify contemporary, relevant cancer quality and outcomes measures by both reevaluating current validated measures and proposing potential new measure concepts to fill crucial gaps.
This article reports on the methods used to derive a priority list of measures and concepts, including those that closely align with existing measures and those that represent novel constructs. The Committee aimed to provide critical support for inclusion of existing measures where appropriate and advance novel measure concepts where necessary in quality programs or value-based models. Additionally, the Committee aimed to lend their collective voice to encourage better alignment across value-based programs in oncology to reduce clinical and administrative burden and promote more meaningful benchmarking across practices.
Sources:
JNCCN