title: Florida Initiative for Quality Cancer Care: improvements on colorectal cancer quality of care indicators during a 3-year interval.
abstract: BACKGROUND
  The quality of cancer care has become a national priority; however, there are few ongoing efforts to assist medical oncology practices in identifying areas for improvement. The Florida Initiative for Quality Cancer Care is a consortium of 11 medical oncology practices that evaluates the quality of cancer care across Florida. Within this practice-based system of self-assessment, we determined adherence to colorectal cancer quality of care indicators (QCIs) in 2006, disseminated results to each practice and reassessed adherence in 2009. The current report focuses on evaluating the direction and magnitude of change in adherence to QCIs for colorectal cancer patients between the 2 assessments.
  
  
  METHODS
  Medical records were reviewed for all colorectal cancer patients seen by a medical oncologist in 2006 (n = 489) and 2009 (n = 511) at 10 participating practices. Thirty-five indicators were evaluated individually and changes in QCI adherence over time and by site were examined.
  
  
  RESULTS
  Significant improvements were noted from 2006 to 2009, with large gains in surgical/pathological QCIs (eg, documenting rectal radial margin status, lymphovascular invasion, and the review of ≥ 12 lymph nodes) and medical oncology QCIs (documenting planned treatment regimen and providing recommended neoadjuvant regimens). Documentation of perineural invasion and radial margins significantly improved; however, adherence remained low (47% and 71%, respectively). There was significant variability in adherence for some QCIs across institutions at follow-up.
  
  
  CONCLUSIONS
  The Florida Initiative for Quality Cancer Care practices conducted self-directed quality-improvement efforts during a 3-year interval and overall adherence to QCIs improved. However, adherence remained low for several indicators, suggesting that organized improvement efforts might be needed for QCIs that remained consistently low over time. Findings demonstrate how efforts such as the Florida Initiative for Quality Cancer Care are useful for evaluating and improving the quality of cancer care at a regional level.
authors.affiliation: Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL. Electronic address: Erin.Siegel@moffitt.org.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Siegel
authors.affiliation: Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: Mokenge
authors.initials: M
authors.lastname: Malafa
authors.affiliation: Department of Biostatistics, Moffitt Cancer Center, Tampa, FL.
authors.forename: William
authors.initials: W
authors.lastname: Fulp
authors.affiliation: Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.
authors.forename: Michelle
authors.initials: M
authors.lastname: Fletcher
authors.affiliation: Center for Cancer Care & Research/Watson Clinic, Lakeland, FL.
authors.forename: Jesusa Corazon R
authors.initials: JC
authors.lastname: Smith
authors.affiliation: Florida Cancer Specialists/Sarasota Memorial Hospital, Sarasota, FL.
authors.forename: Richard
authors.initials: R
authors.lastname: Brown
authors.affiliation: Space Coast Medical Associates, Titusville, FL.
authors.forename: Richard
authors.initials: R
authors.lastname: Levine
authors.affiliation: Ocala Oncology Center, Ocala, FL.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cartwright
authors.affiliation: Robert & Carol Weissman Cancer Center at Martin Memorial, Stuart, FL.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Abesada-Terk
authors.affiliation: Mayo Clinic, Jacksonville, FL.
authors.forename: George
authors.initials: G
authors.lastname: Kim
authors.affiliation: Florida Institute of Research, Medicine, and Surgery, Orlando, FL.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alemany
authors.affiliation: North Broward Medical Center, Deerfield Beach, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Faig
authors.affiliation: Tallahassee Memorial Healthcare, Tallahassee, FL.
authors.forename: Philip
authors.initials: P
authors.lastname: Sharp
authors.affiliation: University of Florida/Shands Cancer Center, Gainesville, FL.
authors.forename: Merry-Jennifer
authors.initials: MJ
authors.lastname: Markham
authors.affiliation: Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL.
authors.forename: David
authors.initials: D
authors.lastname: Shibata
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005431:Florida; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: CRC; FIQCC; Florida Initiative for Quality Cancer Care; LN; LVI; NICCQ; National Initiative for Cancer Care Quality; PNI; QCI; QOPI; Quality Oncology Practice Initiative; colorectal cancer; lymph node; lymphovascular invasion; perineural invasion; quality of care indicator