CC&E: The 1999 Institute of Medicine (IOM) report "Ensuring Quality Cancer Care" recommended the development of a national quality monitoring system. Do you think this recommendation is feasible?
DR. SCHNEIDER: It depends on how we define a national quality monitoring system. To obtain a highly reliable picture of the quality of cancer care may be an expensive undertaking. It requires creative reorganization of the health system in order to collect data at multiple points and feed the data into central receiving areas.
In 2004, my colleagues and I published an article (J Clin Oncol 22:2985-2992, 2004) addressing the key components needed to move forward on a national quality monitoring system. We selected four areas where there was a need for more work.
The first need is the ability to use our registries effectively to obtain population-based samples of patients with cancer so that their care could be comparatively assessed.
The second need is a system sensitive to existing privacy and confidentiality regulations that would protect the privacy of patients while enabling thorough assessment of their cancer care quality.
The third need is deciding how to select a fairly large number of quality measures to assess cancer care. In a sense, we just scratched the surface of this issue. There is a lot of work to do in developing and defining quality measures.
The fourth need has to do with designing a data collection strategy. We collected our data from patient reports, medical record review, and electronic claims and registry data when those were available. It was a cumbersome and labor-intensive method. That said, under the right circumstances and by tailoring the method, I think developing a monitoring system is highly feasible.