Implementing Cancer Treatment Measuring & Reporting in Office & Hospital Practice

描述（由申请人提供）：2007年4月12日，美国外科医生学会（ACoS）癌症委员会与国家质量论坛联合发布了乳腺癌治疗质量措施。5这些被证明可提高生存率的基于证据的辅助治疗措施将要求ACoS认证的医院进行报告。辅助乳腺癌治疗已经转移到分散的门诊设置，并由不同的专家提供。医院肿瘤登记员负责收集来自这些多个站点的治疗数据，但成功率有限。虽然这些治疗报告可用于公开报告和支付奖励方案，但报告不完整仍然是一个问题。ACoS治疗报告干预为更多地了解影响办公室实践和医院肿瘤登记之间信息传递的因素创造了重要机会，并制定了改善这种交流的策略。医生办公室的做法越来越多的行政需求负担几乎没有动力参与ACoS治疗报告干预的实施。实施这种治疗报告干预措施的医院面临的挑战将是让临床医生及其工作人员参与进来，以确保完整和准确的报告，并使实践能够增加报告。在商业领域，通用电气（GE）发现，由于缺乏对变革过程中“人员方面”的关注，三分之二的质量改进工作失败了。GE开发了变革加速过程工具包，强调不同的管理技术，以改善组织变革过程，提高实施成功的可能性。关于CAP对医疗机构的适用性知之甚少。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因素，并在变革加速过程框架内使用这些新知识来开发和测试一种策略，以改善信息传递，作为ACoS治疗报告干预措施实施的一部分。首先，我们将识别和采访数据报告过程中的关键利益相关者，以探索信息流的促进者和障碍。我们还将确定有可能加强社区和医院医生实践与医院肿瘤登记之间的信息交流的策略。其次，利用CAP模型与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策略，以改善社区和医院实践以及肿瘤登记的信息流。第三，为了测试这一实施战略的可行性，我们将在一家医院和一个社区试点这一战略。在策略实施后，我们将采访来自实践和肿瘤登记处的关键人员，以评估实施ACoS治疗报告干预的难易程度、可接受性、资源需求、成本和障碍。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第一步。该提案旨在开发和试点测试一种干预措施，使医院和办公室之间能够就癌症治疗进行信息交流。

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.