Developing clinical indicators for oncology: the inaugural cancer care indicator set for the Australian Council on Healthcare Standards

Abstract

Introduction The Australian Council on Healthcare Standards (ACHS) sponsored an expert‐led, consensus‐driven, four‐stage process, based on a modified Delphi methodology, to determine a set of clinical indicators as quality measures of cancer service provision in Australia. This was done in response to requests from institutional health care providers seeking accreditation, which were additional and complementary to the existing radiation oncology set. The steering group members comprised multidisciplinary key opinion leaders and a consumer representative. Five additional participants constituted the stakeholder group, who deliberated on the final indicator set. Methods and recommendations An initial meeting of the steering group scoped the high level nature of the desired set. In stage 2, 65 candidate indicators were identified by a literature review and a search of international metrics. These were ranked by survey, based on ease of data accessibility and collectability and clinical relevance. The top 27 candidates were debated by the stakeholder group and culled to a final set of 16 indicators. A user manual was created with indicators mapped to clinical codes. The indicator set was ratified by the Clinical Oncology Society of Australia and is now available for use by health care organisations participating in the ACHS Clinical Indicator Program. This inaugural cancer clinical indicator set covers high level assessment of various critical processes in cancer service provision in Australia. Regular reviews and updates will ensure usability. Changes in management as a result of this statement This is the inaugural indicator set for cancer care for use across Australia and internationally under the ACHS Clinical Indicator Program. Multidisciplinary involvement through a modified Delphi process selected indicators representing both generic and specific aspects of care across the cancer journey pathway and will provide a functional tool to compare health care delivery across multiple settings. It is anticipated that this will drive continual improvement in cancer care provision.

Quality indicators for radiation oncology

“…The Australian Council on Healthcare Standards (ACHS) has recently published a consensus for collecting cancer care clinical QIs from administrative data sets excluding ROQIs. 13…”

“…In addition to being evidence‐based, Oncology QIs must be feasible to collect, have validity with clinician ‘buy‐in’ and potentially be able to show variation over space and time. The Australian Council on Healthcare Standards (ACHS) has recently published a consensus for collecting cancer care clinical QIs from administrative data sets excluding ROQIs 13 …”

Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper

“…72 These reports include clinical indicators as tools providing methodologically consistent comparators of service provision across institutions and within various jurisdictions and enable delivery of risk adjusted benchmarking. 73 Performance indicators reported by these state initiatives share a broadly aligned purpose, and measure quality of care using the six dimensions of the Institute of Medicine's Quality of Healthcare framework: safety, effectiveness, patient-centred care, timeliness, efficiency and equity. 74 However, there remains a lack of harmonisation across the states.…”

“…72 These reports include clinical indicators as tools providing methodologically consistent comparators of service provision across institutions and within various jurisdictions and enable delivery of risk adjusted benchmarking. 73 …”

“…A range of Australian regional and state-based initiatives have been developed for improving outcomes in lung cancer care through the use of clinical quality indicators20 65–68 including the Performance Index of the Cancer Institute New South Wales,69 The Queensland Lung Cancer Quality Index,70 Cancer Alliance Queensland71 and the Victorian Lung Cancer Registry (VLCR) 72. These reports include clinical indicators as tools providing methodologically consistent comparators of service provision across institutions and within various jurisdictions and enable delivery of risk adjusted benchmarking 73…”