The Cancer Care Index: A Novel Metric to Assess Overall Performance of a Pediatric Oncology Program

Abstract

Objective Childhood cancer metrics are currently primarily focused on survival rates and late effects of therapy. Our objectives were to design and test a metric that reflected overall quality and safety performance, across all cancer types, of an oncology–bone marrow transplant service line and to use the metric to drive improvement. Method The Cancer Care Index (CCI) aggregates adverse safety events and missed opportunities for best practices into a composite score that reflects overall program performance without regard to cancer type or patient outcome. Fifteen domains were selected in 3 areas as follows: (1) treatment-related quality and safety, (2) provision of a harm-free environment, and (3) psychosocial support. The CCI is the aggregate number of adverse events or missed opportunities to provide quality care in a given time frame. A lower CCI reflects better care and improved overall system performance. Multidisciplinary microsystem-based teams addressed specific aims for each domain. The CCI was widely followed by all team members, particularly frontline providers. Results The CCI was easy to calculate and deploy and well accepted by the staff. The annual CCI progressively decreased from 278 in 2012 to 160 in 2014, a 42% reduction. Improvements in care were realized across most index domains. Multiple new initiatives were successfully implemented. Conclusions The CCI is a useful metric to document performance improvement across a broad range of domains, regardless of cancer type. By the use of quality improvement science, progressive reduction in CCI has occurred over a 3-year period.

Use of quality indicators in neuroblastoma treatment: A feasibility assessment

“…This study continues along the same lines of previous studies into QI feasibility, in other areas of healthcare, where QIs are increasingly being used, such as adult cancer, 25–27 cardiovascular disease, 28 and rheumatology 29 . Knops et al 17 underlined the importance of development of QIs for childhood cancer, and in the past two decades, some sets of QIs have been proposed for pediatric oncology care 30–35 . However, no prior studies were found that investigated NBL QIs specifically.…”

“…29 Knops et al 17 underlined the importance of development of QIs for childhood cancer, and in the past two decades, some sets of QIs have been proposed for pediatric oncology care. [30][31][32][33][34][35] However, no prior studies were found that investigated NBL QIs specifically.…”

Quality Improvement Interventions across a Network of Pediatric Hematology–Oncology Clinics

“…We addressed this challenge by emphasizing the importance of all institutions to meet national standards. 1,15,16…”

A multiyear quality improvement project to increase influenza vaccination in a pediatric oncology population undergoing active therapy

“…Specifically, the oncology program implemented a unique multiyear QI program called the Cancer Care Index that was used to assess program performance across domains of patient harm and clinical care. The goal of the Cancer Care Index was to reduce patient harm and improve desirable clinical outcomes through the reduction of unintended omissions of care, which included providing influenza vaccine …”