title: Changes in the care of non-small-cell lung cancer after audit and feedback: the Florida initiative for quality cancer care.
abstract: OBJECTIVE
  Audit and feedback have been widely used to enhance the performance of various medical practices. Non-small-cell lung cancer (NSCLC) is one of the most common diseases encountered in medical oncology practice. We investigated the use of audit and feedback to improve the care of NSCLC.
  
  
  METHODS
  Medical records were reviewed for patients with NSCLC first seen by a medical oncologist in 2006 (n = 518) and 2009 (n = 573) at 10 oncology practices participating in the Florida Initiative for Quality Cancer Care. In 2008, feedback from 2006 audit results was provided to practices, which then independently undertook steps to improve their performance. Sixteen quality-of-care indicators (QCIs) were evaluated on both time points and were examined for changes in adherence over time.
  
  
  RESULTS
  A statistically significant increase in adherence was observed for five of 16 QCIs. Adherence to brain staging using magnetic resonance imaging or computed tomography scan for stage III NSCLC (57.8% in 2006 v 82.8% in 2009; P = .001), availability of chemotherapy flow sheet (89.2% v 97.0%; P < .001), documentation of performance status for stage III and IV disease (43.4% v 51.3%; P < .001), availability of pathology report for patients undergoing surgery (95.2% v 99.2%; P = .02), and availability of signed chemotherapy consent (69.5% v 76.3%; P = .04). There were no statistically significant decreases in adherence on any QCIs.
  
  
  CONCLUSIONS
  Audit with feedback was associated with a modest but important improvement in the treatment of NSCLC. Whether these changes are durable will require long-term follow-up.
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL tanvett@moffitt.org.
authors.forename: Tawee
authors.initials: T
authors.lastname: Tanvetyanon
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: William J
authors.initials: WJ
authors.lastname: Fulp
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Fred
authors.initials: F
authors.lastname: Schreiber
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Brown
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Levine
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Cartwright
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Abesada-Terk
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: George P
authors.initials: GP
authors.lastname: Kim
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alemany
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Douglas
authors.initials: D
authors.lastname: Faig
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Sharp
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Merry-Jennifer
authors.initials: MJ
authors.lastname: Markham
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Mokenge
authors.initials: M
authors.lastname: Malafa
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa; Center for Cancer Care and Research at Watson Clinic, Lakeland; Florida Cancer Specialists and Research Institute, Sarasota; Spacecoast Cancer Center, Titusville; Ocala Oncology, Ocala; Coastal Oncology and Hematology, Stuart; Mayo Clinic, Jacksonville; Cancer Center of Florida, Orlando; North Broward Medical Center, Deerfield Beach; Tallahassee Memorial Healthcare, Tallahassee; and University of Florida, Gainesville, FL.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D003695:Delivery of Health Care; D005260:Female; D005431:Florida; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008495:Medical Oncology / Q000379:methods* / Q000592:standards*; D008875:Middle Aged; D019984:Quality Indicators, Health Care