C. R. Schlick1, A. H. Adhia1, R. Love1, R. P. Merkow1,2, K. Y. Bilimoria1,2, D. D. Odell1 1Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center, Department Of Surgery,Chicago, IL, USA 2American College Of Surgeons,Division Of Research And Optimal Patient Care,Chicago, IL, USA
Introduction:
Esophageal cancer is a common and lethal condition, with an overall five year survival of less than 15%. Treatment guidelines are complex, and guideline adherence rates are as low as 40%. Yet, robust and comprehensive metrics for the assessment of guideline concordant care are lacking, resulting in variability in the quality of care delivered to patients. Thus, the objective of this study was to develop consensus derived quality measures in esophageal cancer to guide improvements in care.
Methods:
Quality of care measures, including both process and traditional outcome measures, were identified based on established guidelines and a literature review. Multidisciplinary experts from a large academic medical center were asked to rank candidate measures on a 9-point scale for appropriateness to high quality patient care. A modified Delphi consensus-building process based on the RAND/University of California, Los Angeles Appropriateness Methodology was utilized. Candidate measures were considered valid if ranked 7-9 by all but two members during the in-person panel ranking.
Results:
Experts from medical oncology, interventional gastroenterology, thoracic surgery, surgical oncology, radiation oncology, and pathology comprised the panel. Of 38 proposed quality measures, 25 (65.8%) were considered valid. Quality measures focused on diagnosis and staging (e.g., performing EUS, CT and PET for staging), chemotherapy (e.g., utilization of neoadjuvant therapy and evaluation for treatment response), surgery (e.g., adequate lymphadenectomy and negative resection margins), surveillance (e.g., timing and frequency of surveillance CT), and palliation (e.g., offering endoluminal stenting and documenting discussion of nutrition goals). All validated quality measures are listed in Table 1. Quality measures that were not determined to be valid were discarded.
Conclusion:
Valid quality measures were identified across the spectrum of care for esophageal cancer care. Adherence rates to these quality measures will be fed back to hospitals within a statewide quality improvement collaborative to target improvements in esophageal cancer care quality.
