title: Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States?
abstract: OBJECTIVE
  In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer.
  
  
  METHODS
  Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures.
  
  
  RESULTS
  Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n = 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs.
  
  
  CONCLUSIONS
  Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement.
authors.affiliation: RAND Corporation, Santa Monica, CA, USA. jmalin@amgen.com
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Eric C
authors.initials: EC
authors.lastname: Schneider
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy; D002173:Cancer Care Facilities / Q000592:standards*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States