Implementing Cancer Treatment Measuring & Reporting in Office & Hospital Practice

描述(由申请人提供)：2007年4月12日，美国外科医师学会(ACOS)癌症委员会与国家质量论坛联合发布了乳腺癌治疗的质量措施。5这些被证明可提高存活率的循证辅助治疗措施将被要求向获得ACOS认证的医院报告。乳腺癌的辅助治疗已经转移到支离破碎的门诊环境，并由不同的专家提供。医院肿瘤登记员一直负责从这些多个地点收集治疗数据，但收效甚微。虽然这些治疗报告可用于公共报告和支付奖励方案，但不完整的报告仍然存在问题。ACOS治疗报告干预创造了一个重要的机会，可以更多地了解影响以办公室为基础的实践和医院肿瘤登记之间的信息传输的因素，并制定战略来改善这种交流。医生办公室因行政要求增加而负担沉重，几乎没有动力参与ACOS治疗报告干预措施的实施。实施这种治疗报告干预措施的医院面临的挑战将是吸引临床医生及其工作人员，以确保完整和准确的报告，并使实践能够增加报告。在商界，通用电气(GE)发现，三分之二的质量改进努力失败了，原因是缺乏对变革过程中“人的一面”的关注。通用电气开发了变革加速进程(CAP)工具包，强调采用不同的管理技术来改进组织变革进程，以增加实施成功的可能性。人们对CAP在医疗保健环境中的适用性知之甚少。我们建议研究癌症医生和医院肿瘤登记处之间信息交换的障碍和促进者，并在变革加速进程框架内利用这一新知识来开发和测试改善信息传输的战略，作为实施ACOS治疗报告干预措施的一部分。首先，我们将确定并采访数据报告过程中的关键利益相关者，以探索信息流动的促进者和障碍。我们还将确定有潜力的战略，以加强社区和医院医生实践与医院肿瘤登记之间的信息交换。其次，利用CAP模型和本研究第一部分确定的一组关键利益相关者，我们将确定促进治疗报告所需的步骤，并为ACOS的治疗报告干预制定实施战略，以改善社区和医院实践以及肿瘤登记之间的信息流。第三，为了测试这一实施策略的可行性，我们将在一家医院和一家社区实践中试行这一策略。在战略实施后，我们将采访来自诊所和肿瘤登记中心的关键人员，以评估人们对实施ACOS治疗报告干预措施的易用性、可接受性、资源要求、成本和障碍的看法。公共卫生相关性：准确报告癌症治疗信息是提高癌症护理质量的必要第一步。这项提议旨在开发和试点一种干预措施，以实现医院和办公室之间关于癌症治疗的信息交流。

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.