Victorian Lung Cancer Registry
School of Public Health & Preventive Medicine
Monash University, Cancer Research Program
Level 3, 553 St Kilda Road

Melbourne, VIC, 3004
Switch + 61 3 9903 0555  
Fax + 61 3 9903 0576
Email: 
med-vlcr@monash.edu
Web: http://vlcr.registry.org.au

Measuring Quality of Care

Quality of care can be assessed by assessing structures, processes and outcome of care.

Structural Indicators are used to describe the attributes of a setting in which care occurs and the instrumentalities of which it is the product. It may also include administrative and related processes that support and direct the provision of care.1 Structural determinants of quality of care include the adequacy of the building and equipment, the qualifications of the staff and credentialing systems in place to monitor this on an ongoing basis, and whether systems exist to systematically monitor care delivery.

Process indicators refer to the specific activities undertaken as part of the provision of care. They may include the use (or non-use) of various drugs and procedures or aspects of the organisation of care. Process measures can be used as measures of quality of care by comparing treatments given with recommendations in published guidelines or other standards.

Outcome Indicators are measures used to assess the ultimate effects of treatments on health status. In ideal circumstances outcomes would be the only relevant measure of quality of care. However, there are only a limited number of healthcare interventions where the outcome occurs reasonably soon after the intervention and is predominantly determined by the quality of a defined episode of care. In most cases these are surgical or other procedural activities and it is in these situations where outcome measures have their greatest value. Clinical registries provide their distinctive contribution to quality improvement through their role in measuring and benchmarking outcomes.

From “Operating Principles and Technical Standards for Australian Clinical Quality Registries.” 2008. Developed through a collaboration between the Australian Commission on Safety and Quality in Healthcare, NHMRC Centre for Research Excellence in Patient Safety (CRE-PS), and the National E-Health Transition Authority (NEHTA)  

Appendices

1. Donabedian A . Evaluating the quality of medical care. Millbank Quarterly 2005; 83(4):691–729.

VLCR Quality of Care Indicators

Diagnosis and Staging

Documentation of:

  • ECOG
  • Loss of Weight
  • Clinical TNM
  • MDM case discussion
  • Radiotherapy
  • Palliative care

Proportion of surgical patients with:

 

  • Preoperative Ct reported
  • PET reported
  • EBUS reported
  • Preoperative mediastinoscopy reported
  • Patients with tissue diagnosis
  • Patients with no tissue diagnosis

Pathology

Proportion of  diagnoses  achieved by:

 

  • Cytology (sputum / bronchial washings)
  • EBUS specimen
  • CT guided biopsy
  • Surgically resected specimen

Proportion of reports with:

 

  • Immunohistochemistry analysis
  • Labelled lymph node analysis
  • Pathological TNM reported
  • Consistency with IASLC/ATS/ERS guidelines

Coordination of care

Time form diagnosis to:

  • Referral
  • MDM Discussion
  • First definitive treatment (surgery, chemotherapy or radiotherapy)
  • Palliative care

Time from referral to:

  • MDM Discussion
  • Diagnosis
  • First definitive treatment (surgery, chemotherapy or radiotherapy)
  • Palliative care

Time from presentation at first Multi-Disciplinary Team Meeting to:

  • First definitive treatment (surgery, chemotherapy or radiotherapy)
  • Palliative care

Proportion of patients with Stage II-III NSCLC who had Surgical treatment

 

Interval between commencement from chemotherapy and radiotherapy for stage III – IV patients, ECOG ≤ 2, receiving chemo radiotherapy.

 

Treatment

Number of  Surgically treated patients with:

 

  • Wedge resection
  • Lobectomy
  • Pneumonectomy
  • Lymph nodes resected

Proportion of advanced NSCLC (Stage III-IV, ECOG ≤ 2)

 

  • receiving chemotherapy
  • chemotherapy treated patients receiving platinum based couplet therapy
  • Inoperable (locally advanced) NSCLC patients (Stage III-IV, ECOG ≤ 2) receiving radiotherapy

Proportion of patients who were:

  • Referred to palliative care
  •  Enrolled in clinical trial

Patient related outcomes

Quality of Life

  • At 6 and 12 months post diagnosis

ECOG

  • At Baseline
  • At 6 and 12 months post diagnosis

Survival

  • Updated in published reports

Proportion of patients with documented distress screening performed at baseline

  • At Baseline