Differences in pregnant and non-pregnant women's alcohol and drug use, substance treatment need, and treatment receipt were examined using The National Survey of Drug Use and Health (2002-2006). Treatment need and receipt were defined by either self-report or DSM-IV criteria. Pregnant women were less likely to use alcohol and drugs than non-pregnant women. Among women who use drugs, pregnant women were more likely to need treatment (odds ratio (OR) = 1.92; 95% confidence interval (CI): 1.46, 2.52), however they were not more likely to receive treatment (OR = 0.90; 95% CI: 0.54, 1.51). Overall, there is an unmet need for treatment among reproductive-aged substance users.
QUESTION ASKED: What is the relationship between the level of implementation of multidisciplinary care (MDC) and various processes of cancer care (eg, time to treatment receipt, evaluation for enrollment onto a clinical trial) among community cancer centers serving patients diagnosed with colon, rectal, or lung cancer? There is limited generalizable evidence on this topic. It is important to answer this question using data that can generalize across cancer patients, the majority of whom receive treatment in a community cancer center. SUMMARY ANSWER: Focusing on the time to receipt of cancer-directed treatment as one key process of cancer care in this patient population, we found that the answer to our question depended on the MDC assessment area and tumor site ( Table 1 ). Among patients with colon cancer, higher MDC levels of physician engagement (ie, a higher level of physician engagement at the institutional level) were associated with a shorter time to treatment receipt, whereas higher MDC levels of case planning were associated with a longer time to treatment receipt. Among patients with rectal cancer, higher MDC levels of physician engagement were associated with a shorter time to cancer-directed treatment receipt, whereas higher MDC levels of evaluation for enrollment onto clinical trials were associated with a longer time to treatment receipt. Among patients with lung cancer, there was no association between the MDC areas of assessment and the time to cancer-directed treatment receipt. [Table: see text] METHODS: We collected data for patients receiving care at 14 National Cancer Institute (NCI) community cancer centers. We characterized the NCI community cancer centers according to their level of MDC implementation across seven MDC assessment areas and over time. Using statistical regression models, we investigated the relationship between the level of MDC implementation and various process measures, including time to treatment receipt, clinical trial evaluation, receipt of multimodality treatment, and adherence to treatment guidelines published by the National Comprehensive Cancer Network. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: In the absence of a validated MDC assessment tool, the NCI community cancer centers used a nonvalidated tool. Additional institutional-level data would have been useful for characterizing norms and practices that may have differed across cancer centers and potentially explained variation in care processes. Although we controlled for patient demographic characteristics, baseline data were not available to document patient comorbidity or performance status level. To the extent that cancer centers at higher levels of MDC implementation may have been more likely to treat clinically complex patients, the inability to control for potential confounding bias caused by patient case mix may have influenced the study results. REAL-LIFE IMPLICATIONS: MDC models are important decision-making forums in current oncology practice. They involve oncologists in generating a comprehensive and coordinated plan of care for patients. Although MDC is purported to offer benefits to patients, there is limited generalizable evidence regarding the benefit to individuals receiving care at community cancer centers in the United States. Across various care processes that are important for characterizing cancer care, this study’s results indicate that changes in the level of MDC implementation could differentially affect the process of care, depending on the MDC area of assessment and the cancer site. In addition, the study results can be used to generate hypotheses for future studies among individuals diagnosed with colon, rectal, or lung cancer.
Purpose: Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. Methods:We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression.Results: Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparisongroup hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. Conclusion: Both NCCCP and comparison-group hospitalsshowed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.
The multidisciplinary Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), administered by the American College of Surgeons (ACoS), defines evidence and consensus-based standards, require an operational infrastructure, collect high quality cancer data, and validate compliance with standards through external peer review. A survey of our constituents confirms a high level of agreement that accreditation is regarded as important in improving oncologic outcomes through compliance with standards that include continuous quality improvement.
6088 Background: RQRS is a cancer registry based tool for rapid case ascertainment and real-time care tracking using 5 National Quality Forum approved quality measures for breast (BC) and colon cancer (CC) and 1 American Society of Clinical Oncology, National Comprehensive Cancer Network and Commission on Cancer (CoC) endorsed rectal cancer (RC) measure. RQRS was introduced in 2009 for testing at selected CoC accredited programs. The purpose of this study was to evaluate the proportion of cases with treatment administered for 4 measures where care is concordant with treatment either “administered” or “considered but not administered” (CNA). Methods: Case information on 19,631 breast, colon and rectal cancer patients diagnosed from 2009 – 2010 submitted by 64 RQRS participating sites were reviewed for 4 measures: (1) hormone therapy within 1 year of diagnosis (dx) for AJCC T1c, N0M0, or stage II or II; hormone receptor positive BC (HT), (2) multi-agent chemotherapy within 4 months of dx; age < 70; hormone receptor negative BC (MAC), (3) adjuvant chemotherapy within 4 months of dx; age <80; AJCC Stage III CC (ACT), and (4) radiation therapy within 6 months of dx; age <80; AJCC T4N0M0 or stage III patients receiving surgical resection for RC (AdjRT). Treatment status was defined as concordant (administered or CNA) or non-concordant (NC – not part of planned first course therapy or received after required time frame). Patient demographics and Charlson-Deyo (CD) co-morbidity scores were compared by concordance status using Chi-square tests. Results: The aggregate concordance rate was 83.3%. Among these 889 (5.4%) were CNA. Co-morbidity score was > 0 for 15% of cases. Patients age > 70, with Medicare insurance, CD score > 0 were significantly more likely to be CNA compared to completed or NC. Patient choice was the most common reason for CNA (64%). Conclusions: Among patients treated at RQRS test sites for which RQRS measures applied and care was concordant, only 5% were CNA. Patients over age 70 or with CD > 0 were more likely to have treatment CNA. Inclusion of CNA as concordant care has a minor impact on concordance rates and provides cancer programs with important information for targeting care review and quality improvement programs.
286 Background: The Rapid Quality Reporting System (RQRS), developed by The Commission on Cancer of The American College of Surgeons, allows accredited cancer programs to prospectively monitor adherence to five National Quality Forum endorsed quality of care metrics for breast (BC) and colon (CC) cancer. This study assesses differences in performance rates by patient populations and demonstrates the impact a prospective clinical performance tracking system can have in impacting care. Methods: RQRS tracks and measures compliance with the following measures: Radiation therapy within one year of diagnosis (dx) for women <70 receiving breast conserving surgery for BC (BCS/RT); hormone therapy within one year of dx for AJCC T1c, N0M0, or stage II or II; hormone receptor positive BC (HT); multi-agent chemotherapy within four months of dx; age < 70; hormone receptor negative BC (MAC); adjuvant chemotherapy within four months of dx; age <80; AJCC stage III CC (ACT); pathologic examination of ≥12 regional lymph nodes for surgically resected CC (12RLN). 64,129 RQRS measure eligible cases diagnosed from 2006 to 2010 from 64 RQRS beta test centers were assessed. Performances rates, before and after implementing the RQRS beta test, were compared by patient demographics. Results: Between 2006 to 2010, compliance rates increased significantly for all five measures, ranging from a 16% increase for MAC to 36% for HT. Prior to RQRS participation, BCS/RT, HT and ACT compliance was significantly lower in patients of other races cf. to white and black; for MAC, other races were lower cf. to white. By 2010 a difference by race remained only in BCS/RT. Payer status and age also impact care. Private insurance cases were more likely to receive compliant care for BCS/RT, MAC and 12RLN; with Medicare for HT (p<.05). Age impacted HT (<40 less likely) and ACT (70-79 less likely cf. to 40-49) (p<.05). Conclusions: Increased performance rates show a system which promotes the ability to track patients in real clinical time can improve quality of care. By using RQRS to prospectively monitor expected adjuvant care, programs can proactively intervene and address potential issues that could impede delivery of timely standard of care.
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