Improving quality of cancer care at community hospitals: impact of the National Cancer Institute Community Cancer Centers Program pilot.
OBJECTIVE
Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP.


METHODS
We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression.


RESULTS
Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparison-group hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals.


CONCLUSIONS
Both NCCCP and comparison-group hospitals showed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.
RTI International, Washington, DC, and Research Triangle Park, NC; American College of Surgeons, Chicago, IL; and National Cancer Institute, Bethesda, MD.
Michael T
MT
Halpern
Pamela
P
Spain
Debra J
DJ
Holden
Andrew
A
Stewart
Erica J
EJ
McNamara
Greer
G
Gay
Irene Prabhu
IP
Das
Steven
S
Clauser
D001943:Breast Neoplasms / Q000628:therapy*; D003110:Colonic Neoplasms / Q000628:therapy*; D005260:Female; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D054547:National Cancer Institute (U.S.); D010865:Pilot Projects; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D011787:Quality of Health Care; D014481:United States