title: Concordance with NCCN Colorectal Cancer Guidelines and ASCO/NCCN Quality Measures: an NCCN institutional analysis.
abstract: BACKGROUND
  The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers.
  
  
  METHODS
  Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers.
  
  
  RESULTS
  A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high ( >or= 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81%), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers.
  
  
  CONCLUSIONS
  Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.
authors.affiliation: Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Romanus
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Anna
authors.initials: A
authors.lastname: Ter Veer
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.forename: John L
authors.initials: JL
authors.lastname: Wilson
authors.forename: Ashwani
authors.initials: A
authors.lastname: Rajput
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Stephen
authors.initials: S
authors.lastname: Shibata
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011786:Quality Control