Implementing Cancer Treatment Measuring & Reporting in Office & Hospital Practice

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DESCRIPTION (provided by applicant): On April 12, 2007, the American College of Surgeons' (ACoS) Commission on Cancer in conjunction with the National Quality Forum released quality measures for the treatment of breast cancer.5 These evidence-based measures of adjuvant treatments proven to increase survival will be required reporting for hospitals accredited by the ACoS. Adjuvant breast cancer treatment has moved to the fragmented out- patient setting and is provided by different specialists. Hospital tumor registrars have been responsible for assembling treatment data from these multiple sites with limited success. While these treatment reports can be used for public reporting and payment incentive programs incomplete reporting remains problematic. The ACoS treatment-reporting intervention creates an important opportunity to learn more about factors that affect information transfer between office-based practices and the hospital tumor registry, and to devise strategies to improve that exchange. Physician office practices burdened by increasing administrative demands have little incentive to participate in implementation of the ACoS treatment-reporting intervention. The challenge for hospitals implementing this treatment-reporting intervention will be to engage clinicians & their staff to ensure complete & accurate reporting, and enable the practices to increase reporting. In the business world, General Electric (GE) found that 2/3 of quality improvement efforts failed due to lack of attention to the "people side" of the change process. GE developed the Change Acceleration Process (CAP) Toolkit emphasizing different management techniques to improve organizational change processes to increase the likelihood of implementation success. Little is known about CAP's applicability to healthcare settings. We propose to study barriers to and facilitators of information exchange between cancer physicians and a hospital tumor registry and use this new knowledge within the Change Acceleration Process framework to develop and test a strategy to improve information transfer as part of implementation of the ACoS treatment- reporting intervention. First, we will identify and interview key stakeholders in the data reporting process to explore facilitators & barriers to information flow. We will also identify strategies with the potential to enhance information exchange between community- and hospital-based physician practices and the hospital's tumor registry. Second, utilizing the CAP model with a group of key stakeholders identified during the first part of this study, we will identify the steps needed to facilitate treatment reporting and devise an implementation strategy for ACoS's treatment-reporting intervention that will improve information flow across community- and hospital- based practices and the tumor registry. Third, to test the feasibility of this implementation strategy, we will pilot the strategy in one hospital- and one community-based practice. After strategy implementation, we will interview key personnel from the practices and the tumor registry to assess perceptions of ease, acceptability, resource requirements, costs and barriers to implementing the ACoS's treatment-reporting intervention. PUBLIC HEALTH RELEVANCE: Accurate reporting of cancer treatment information is a required first step to improve the quality of cancer care. This proposal aims to develop and pilot test an intervention to enable information exchange between hospitals and office practices about cancer treatment.