title: Developing a system to track meaningful outcome measures in head and neck cancer treatment.
abstract: BACKGROUND
  The health care industry, including consumers, providers, and payers of health care, recognize the importance of developing meaningful, patient-centered measures. This article describes our experience using an existing electronic medical record largely based on free text formats without structured documentation, in conjunction with tumor registry abstraction techniques, to obtain and analyze data for use in clinical improvement and public reporting.
  
  
  METHODS
  We performed a retrospective analysis of 2467 previously untreated patients treated with curative intent who presented with laryngeal, pharyngeal, or oral cavity cancer in order to develop a system to monitor and report meaningful outcome metrics of head and neck cancer treatment. Patients treated between 1995 and 2006 were analyzed for the primary outcomes of survival at 1 and 2 years, the ability to speak at 1 year posttreatment, and the ability to swallow at 1 year posttreatment.
  
  
  RESULTS
  We encountered significant limitations in clinical documentation because of the lack of standardization of meaningful measures, as well limitations with data abstraction using a retrospective approach to reporting measures. Almost 5000 person-hours were required for data abstraction, quality review, and reporting, at a cost of approximately $134,000. Our multidisciplinary teams document extensive patient information; however, data is not stored in easily accessible formats for measurement, comparison, and reporting.
  
  
  CONCLUSIONS
  We recommend identifying measures meaningful to patients, providers, and payers to be documented throughout the patients' entire treatment cycle, and significant investment in the improvements to electronic medical records and tumor registry reporting in order to provide meaningful quality measures for the future.
authors.affiliation: Department of Medical Operations and Informatics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Walters
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Albright
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Feeley
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.forename: Carol M
authors.initials: CM
authors.lastname: Lewis
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000628:therapy; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010610:Pharyngeal Neoplasms / Q000628:therapy; D011788:Quality of Life; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: cancer measures; cancer metrics; cancer outcomes; head and neck cancer; laryngeal cancer; oral cancer; oropharyngeal cancer; outcomes of care; public reporting; tracking system