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UCLA cancer researchers develop quality measures for colorectal cancer surgery

Guidelines should improve patient care

A set of quality measures used to evaluate the quality of care received by patients undergoing surgery for colorectal cancer has been created by UCLA researchers in an effort to improve care before, during and after the surgery.

Improving the quality of surgical care for colorectal cancer patients is vital as the number of resections continues to increase in an aging population, said Dr. Clifford Ko, an associate professor of surgery, a researcher at UCLA's Jonsson Cancer Center and lead author of the study. About 148,000 people will get colorectal cancer this year alone, and about 90 to 95 percent of those will undergo surgery.

Colorectal cancer is the second most common cancer type among new cancers being diagnosed in the United States and as such, is treated at major academic medical centers as well as in community hospitals and surgical centers. Because it is treated in so many different places, guidelines outlining the best care for patients provide a valuable tool.

Ko and his colleagues came up with 92 quality of care indicators in six broad areas that encompass everything from surgeon credentials to patient-care provider discussions to medication use. The study is published in the Nov. 15 of the Journal of the National Cancer Institute.

The new quality indicators cover all aspects of surgical care, including a patient's health evaluation before the surgery to the most appropriate surgical techniques to resect varying types of colorectal cancer to creating a list of medications the patient already is taking to avoid dangerous interactions. The new quality indicators, which expand on a set of practice guidelines created by the National Cancer Institute in 2000, also detail the best post-operative patient management practices.

"You can do the best operation in the world, but it doesn't mean much if the patient doesn't do well after surgery," Ko said.

To come up with the quality indicators, Ko and his team carried out structured interviews with leaders in the field of colorectal cancer surgery, as well as a systematic review of the literature. A panel of 14 colorectal surgeons, general surgeons and surgical oncologists then evaluated the list and rated the indicators for validity, Ko said.

Of the 142 indicator on the original list, 92 were determined to be valid by the panel of experts and now make up the new list of quality indicators.

Ko and his team hope the quality indicators will be used as a checklist by surgeons and others in the community caring for colorectal cancer surgery patients. Most healthcare professionals probably already are doing some of the things on the checklist, Ko said, but the quality measures could serve as a safeguard to ensure that everything that should be done actually gets done.

"If we do all the right things, the patient will do better before, during and after surgery," Ko said. "The more information we have, the better job we can do."

The new quality indicators will be distributed to healthcare professionals in the community in CD form. Additionally, UCLA researchers will be presenting their work at conferences and meetings in order to raise awareness about the new quality indicators. Ko said the indicators can be used by individual institutions to measure the quality of their care as well as devise ways to improve it.

"These indicators identify potentially meaningful and important steps for providing high quality of care among health care systems, hospitals and providers offering surgical care to patients with colorectal cancer," the study states.

Quality of care measures have been developed for many diseases. They're used by regulatory agencies such as the Centers for Medicare and Medicaid Services to evaluate quality of care in a variety of diseases. Until now, no quality of care indicators had been developed for colorectal cancer other than the NCI's practice guidelines.

Ko and his team next will use the quality of care indicators to determine if they impact a patient's outcome after colorectal cancer surgery. They hope to determine if there are any further ways that surgeons and others caring for colorectal cancer patients can improve outcome, prognosis and quality of life.

Kim Irwin | EurekAlert!
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