Quality Cancer Care Committee

Why? The ability to fight cancer successfully depends on access to the right resources, the best treatment and every available support service.

The more options a cancer patient has, the better the chances for survival. In Delaware, not only are we focusing on improving access to screenings—we are making it a priority to remove the obstacles to getting care once cancer is diagnosed. The Cancer Care Coordinators will continue to play a key role in helping patients find the services they need. We will also make sure people are more aware of clinical trials that may benefit them. We’ll be examining our own programs to improve them and make them more accessible.

WHAT CAN BE DONE

Continuation of the Cancer Care Coordination Program that has helped 2,646 people services from July 1, 2005 to June 30, 2007.
Examine any obstacles that continue to hinder access to care.
Improve information about clinical trials and make sure cancer patients know they are an option for them.
Talk to health care providers—such as oncologists and cancer surgeons—to understand where they feel help is needed.
Review medical records to get an update on quality measures for specific types of cancer.
Help people who have been successfully treated for cancer find resources to support them as survivors.
Enhance the capture of all data from the Cancer Care Coordinator program and other related activities.

A STUDY BY THE TEXAS MEDICAL FOUNDATION ASSESSED PHYSICIAN USE OF TOOLS AVAILABLE TO THEM.

Click each goal to read about the objectives, tasks and timeframes.

Goal 1:

Ensure Delawareans access to the highest-quality cancer screening and care.

Year 1

$80,000

Year 2

$85,000

Year 3

$15,000

Year 4

$15,000

Objective 1A: Increase cancer screening in primary care practices.

Task/Action	Responsible Party	Timeframe
Identify means to approach primary care practices to improve screening including “Academic Detailing.”Implement educational effort using standardized screening tool.Track performance subsequent to educational effort.Using previous study (by Texas Medical Foundation [TMF]) as baseline, develop pre-/post-educational effort comparison; publish findings and expand efforts as indicated.	DPA, DCC	Years 1 & 2
Explore and evaluate coverage provided by self-insured employers (who are exempt from coverage mandates applying to other insurers) for cancer screening and care and explore evaluate affordable options (e.g., broad v. narrow coverage): ScreeningCare—inpatient, outpatient, prescription drugsAccess to clinical trials	State Chamber of Commerce; self-insurers; interested members of both Quality and Workplace/Workforce Committees	Year 1

Objective 1B: Assess availability of health care providers.

Task/Action	Responsible Party	Timeframe
Assess statewide availability of appropriate health care providers (e.g., oncologists, cancer surgeons) especially in previously identified key shortage areas.	DPH, University of DE and/or Health Care Commission	Year 1

Objective 1C: Implement routine monitoring of quality measures for cancer care, starting with the most prevalent Delaware cancers (breast, colorectal, lung and prostate).

Task/Action	Responsible Party	Timeframe
Implement—via medical records review—the American Society of Clinical Oncology (ASCO) / National Comprehensive Cancer Network (NCCN) Quality Measures for Breast and Colorectal Cancers.	ACoS Delaware Commission on Cancer, DCC	Year 1
As ASCO/NCCN Quality Measures are published, implement them for cervical, lung/bronchus and prostate cancers, check the quality of ACoS-provided data by chart review.	ACoS Delaware Commission on Cancer, DCC	Years 2 & 3
Ensure Delawareans are aware of the results of cancer care quality measures by disseminating information on performance measures to all segments of the public including preparing annual, specific report cards to rate performance on quality measures.	DCC, DPH	Year 4

Goal 2:

Ensure quality of care—and life—available to Delaware’s cancer survivors.

Year 1

$60,000

Year 2

$10,000

Year 3

$100,000

Year 4

$100,000

Objective 2A: Ensure Delawareans are enabled to participate in state-of-the-art cancer clinical trials.Task/Action Responsible party

Task/Action	Responsible Party	Timeframe
Ensure Delawareans are aware of option to participate in cancer clinical trials through distribution of educational materials to all patients newly diagnosed with cancer.	Healthcare providers	Year 1 & ongoing
Assess need for and recommend statewide infrastructure to support clinical trial enrollment.	DCC	Year 2
Devote 1.0 FTE to provide infrastructure to support clinical trial enrollment.	DCC	Years 3 & 4
Include clinical trial support and participation as a quality indicator in report cards mentioned in Objective 1C.	DPH, DCC	Year 4

Objective 2B: Implement routine capture of information on patients contacted about entering clinical trials.

Task/Action	Responsible Party	Timeframe
Identify hospital-specific point people for clinical trial information and enrollment.	DCC, DPH	Year 1
Meet with clinical trial point people to discuss tracking and data capture options.	DCC, DPH	Year 1
Implement agreed-upon approach; track and monitor (via database) patient contact and enrollment statistics at a facility-specific level on a quarterly basis.	DCC, DPH	Year 2
Request institutions to provide yearly data on patients accessing and enrolling into clinical trials and track these data.	DCC, DPH	Year 1

Goal 3:

Ensure continuity of care through cancer care coordination.

Year 1

$800,000

Year 2

$880,000

Year 3

$901,000

Year 4

$885,000

Objective 3A: Continue implementation of the Cancer Care Coordinator program.

Task/Action	Responsible Party	Timeframe
Contract with vendors through RFP process to deliver Cancer Care Coordinator program services.	DPH	Year 1 & ongoing

Objective 3B: Extend availability of Cancer Care Coordinator services beyond the treatment phase, promoting continuity of care into the survivor phase of care.

Task/Action	Responsible Party	Timeframe
Evaluate extent of interest among patients served to continue relationship with Cancer Care Coordinator beyond treatment phase of care.	DPH	Year 1
Ensure sufficient services of Cancer Care Coordinators so that all Delawareans with cancer who desire care coordination services are able to access them;Assess current level of effort.Determine extent to which unmet need exists.Recommend capacity required to fulfill needs.	DPH	Year 2
Evaluate level of additional effort required; recommend staffing changes and additions accordingly	DPH	Year 1
Promote use of extended services among those receiving Cancer Care Coordinators’ services.	Cancer Care Coordinators, cancer care coordination managers, DPH	Year 2

Objective 3C: Expand and enhance capture of Cancer Care Coordinator patient contact data.

Task/Action	Responsible Party	Timeframe
Contract with vendor through RFP to expand current colorectal Cancer Screening Nurse Navigator database to include client-specific, electronic database for use by Cancer Care Coordinators.	DPH	Year 1
Implement client-specific, electronic database for use by Cancer Care Coordinators.	DPH	Year 1
Implement comprehensive satisfaction surveys among patients served, Cancer Care Coordinators and facilities/health care providers whose patients received coordination services, using existing, validated survey instruments; link results to client-specific database.	DPH, facility-based patient ombudsmen, Cancer Care Coordinators, cancer care coordination managers, physicians/health care providers	Year 3
Conduct patient surveys among patients willing to be contacted after case closure—e.g., six months post-care coordination service delivery—to assess current status, level of functioning, return to work, treatments received during post-care interval, etc.; link results to client-specific database.	DPH	Year 3

Objective 3D: Expand surveillance and evaluation of Cancer Care Coordinator activities.

Task/Action	Responsible Party	Timeframe
Develop and implement comprehensive reporting system that leverages data captured in electronic database and supports analysis of patient contact data by, for example, contact, client, Cancer Care Coordinator, demographic variables, etc.	DPH, Cancer Care Coordinators, cancer care coordination managers	Year 2
Publish reports of coordinator and facility performance; reports should include both object and subject components.	DPH	Year 3

Goal 4:

Ensure availability of accurate, complete data to allow effective surveillance of cancer incidence, care delivery and treatment.

Year 1

$350,000

Year 2

$490,000

Year 3

$440,000

Year 4

$435,000

Objective 4A: Maintain operations of the Delaware Cancer Registry program.

Task/Action	Responsible Party	Timeframe
Ensure Delaware Cancer Registry (DCR) operations are maintained and supported.	DPH	Year 1 & ongoing
Ensure adequate software support to maintain DCR.	DPH	Year 1 & ongoing

Objective 4B: Improve capture of treatment-related data and accurate staging data in the Delaware Cancer Registry (DCR); maintain highest quality standards of oversight agencies (North American Association of Central Cancer Registries [NAACCR] and National Program of Cancer Registries [NPCR]).

Task/Action	Responsible Party	Timeframe
Determine feasibility/desirability of implementing regulation requiring submission of treatment data along with other follow-up information (already collected).	DPH	Year 1
Evaluate web-based case submission mechanisms that would enable faster, easier and more secure data submission.	Information Technology Task Force (ITTF) of DCR advisory committee, registry director, manager and staff, Delaware Information Technology Group	Year 1
Implement web-based case submission mechanism, enabling faster, easier and more secure data submission.	Information Technology Task Force (ITTF) of DCR advisory committee, registry director, manager and staff, Delaware Information Technology Group	Years 2–4
Explore feasibility and possible approaches to capturing more complete historic (2000 forward) treatment data.	DPH, DCR advisory committee	Year 2
Develop means by which to support additional reporting required of providers; e.g., financial incentives, staffing assistance, e.g., “Circuit Rider” registrar.	DPH, DCRAC registry staff, registry director	Years 2–4

Objective 4C: Expand ongoing surveillance and evaluation of Delaware Cancer Registry activities.

Task/Action	Responsible Party	Timeframe
Publish periodic reports of quality-related activities (e.g., submission timeliness, completeness, and quality).	DCR staff, DCRAC	Year 1 & ongoing
Report annual NAACCR and NPCR submission requirements for DCR and make public NAACCR and NPCR findings.	DCR staff, registry director	Year 1 & ongoing
Ensure improved quantity and quality of treatment data in the DCC; Establish standards reporters must meet in submitting treatment-related data.Implement systematic review of the accuracy and completeness of treatment data submitted to the DCR.Conduct external physician review of hospital registries and central registry.	DDPH, ITTF, DCRAC, registry staff, registry director	Year 2 & ongoing
Conduct external review comparing data from the central DCR to hospital medical records.	DPH	Year 2 & ongoing
Ensure distribution of quality-related information to interested affected parties, e.g., data reporters (hospital and non-hospital reporters), researchers using data, Delaware Cancer Consortium, members of the public.	DPH, DCR staff, DCRAC	Year 3 & ongoing

Objective 4D: Conduct ongoing evaluation of effort to acquire and analyze supplementary cancer-related data.

Task/Action	Responsible Party	Timeframe
Track progress, via bimonthly reports, of acquiring and processing data from one health insurer	DPH, health insurer, DCR staff	Year 3
Evaluate usefulness of health insurer data results; recommend continuation, expansion and/or discontinuation of health insurer data capture effort.	DCR staff, DPH Staff	Year 3
Monitor, via bimonthly reporting, continuation and/or expansion of health insurer data capture effort.	DCR staff, DPH Staff	Year 4
Monitor progress on the feasibility study of acquiring prescription drug data not available through health insurer(s), through semiannual reporting; upon completion of study, review, evaluate and make recommendations on pursuing acquisition of these data.	DCR staff, DPH Staff	Year 4
Monitor progress on the feasibility study of acquiring Claritas demographic and consumer purchasing data, through semiannual reporting; upon completion of study, review, evaluate and make recommendations on pursuing acquisition of these data.	DCR staff, DPH Staff	Year 4