Quality improvement in melanoma care: Multidisciplinary quality program development and comparison of care before and after implementation

Kielhorn, Barrett A.; Jantz, Jensen B.; Kosten, Mark S.; Phillips, Stephen S; Khandavalli, Sarat C.; McCahill, Laurence E.

doi:10.1016/j.amjsurg.2018.10.025

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Continuously measuring and reporting on quality indicators for melanoma and other cancers is crucial, as it may contribute to reducing inappropriate practice variation, and improving outcomes [11]. However, collecting and compiling the information required to do so can be resource intensive, time consuming and costly.…”

Section: Introductionmentioning

confidence: 99%

A population-based study of administrative data linkage to measure melanoma surgical and pathology quality

et al. 2022

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Background Continuous quality improvement is important for cancer systems. However, collecting and compiling quality indicator data can be time-consuming and resource-intensive. Here we explore the utility and feasibility of linked routinely collected health data to capture key elements of quality of care for melanoma in a single-payer, universal health care setting. Method This pilot study utilized a retrospective population-based cohort from a previously developed linked administrative data set, with a 65% random sample of all invasive cutaneous melanoma cases diagnosed 2007–2012 in the province of Ontario. Data from the Ontario Cancer Registry was utilized, supplemented with linked pathology report data from Cancer Care Ontario, and other linked administrative data describing health care utilization. Quality indicators identified through provincial guidelines and international consensus were evaluated for potential collection with administrative data and measured where possible. Results A total of 7,654 cases of melanoma were evaluated. Ten of 25 (40%) candidate quality indicators were feasible to be collected with the available administrative data. Many indicators (8/25) could not be measured due to unavailable clinical information (e.g. width of clinical margins). Insufficient pathology information (6/25) or health structure information (1/25) were less common reasons. Reporting of recommended variables in pathology reports varied from 65.2% (satellitosis) to 99.6% (body location). For stage IB-II or T1b-T4a melanoma patients where SLNB should be discussed, approximately two-thirds met with a surgeon experienced in SLNB. Of patients undergoing full lymph node dissection, 76.2% had adequate evaluation of the basin. Conclusions We found that use of linked administrative data sources is feasible for measurement of melanoma quality in some cases. In those cases, findings suggest opportunities for quality improvement. Consultation with surgeons offering SLNB was limited, and pathology report completeness was sub-optimal, but was prior to routine synoptic reporting. However, to measure more quality indicators, text-based data sources will require alternative approaches to manual collection such as natural language processing or standardized collection. We recommend development of robust data platforms to support continuous re-evaluation of melanoma quality indicators, with the goal of optimizing quality of care for melanoma patients on an ongoing basis.

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Section: Introductionmentioning

confidence: 99%

A population-based study of administrative data linkage to measure melanoma surgical and pathology quality

et al. 2022

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“…As demonstrated in other studies [17,18], such indicators are used to assess the quality of care processes, equity and continuity. Some studies analysed adherence to clinical guidelines in oncology [19][20][21][22], and the effects of applying the guidelines to certain melanoma outcomes [23], but we still know little about how quality affects patient survival and the average cost of care per patient. It would also be useful to examine how quality affects resource consumption, in order to rationalize expenditure and allocate available resources in the best possible way.…”

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confidence: 99%

Quality management of cutaneous melanoma: impact on short-term outcomes and costs

Buja¹,

Luca²,

Zorzi³

et al. 2021

European Journal of Dermatology

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Background: Promoting standardization and quality assurance (QA) may guarantee better outcomes for patients and ensure a better allocation of healthcare system resources. Objectives: The present study tested the association between process quality indicators of the clinical pathway for melanoma and both patient short-term mortality and budget utilization. Materials & Methods: Specific indicators were selected to assess quality of processes in different phases of the pathway as well as the pathway as a whole. Cox regression models were run for each phase to test the association between adherence to the quality indicator and overall mortality. A Tobit regression analysis was used to identify any association between adherence to the quality indicators and total costs over the two years after melanoma was diagnosed. Results: This retrospective cohort study concerned 1,222 incident cases of melanoma in the Veneto Region (north-east of Italy). Adherence to the clinical pathway as a whole was associated with a significant decrease in risk of death (HR= 0.40; 95% CI: 0,19 -0,77). Adherence to quality processes in the diagnostic phase (HR= 0.55 95% CI: 0.31-0.95) and surgical phase (HR= 0.33 95% CI: 0.16-0.61) significantly reduced the hazard risk. Tobit regression revealed a significant increase in overall costs for patients who adhered to the whole pathway in comparison with those who did not (␤= 2,393.24; p= 0.013). Conclusion: This study suggests that adherence to the quality of management of clinical pathways modifies short-term survival as well as mean cost of care for patients with cutaneous melanoma. Physicians should be encouraged to improve their compliance with clinical care pathways for their melanoma patients, and steadily growing associated costs emphasize the need for policy makers to invest exclusively in treatments of proven efficacy.

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Quality improvement in melanoma care: Multidisciplinary quality program development and comparison of care before and after implementation

Cited by 2 publications

References 11 publications

A population-based study of administrative data linkage to measure melanoma surgical and pathology quality

A population-based study of administrative data linkage to measure melanoma surgical and pathology quality

Quality management of cutaneous melanoma: impact on short-term outcomes and costs

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