Clinical Focus on Quality
The Oncology Clinical Program, like other Intermountain Healthcare clinical programs, was established to enhance quality by standardizing care delivery and reducing practice variation. This requires collecting and evaluating outcome data and constructively engaging physician leaders with cancer-specific expertise and the communication skills necessary to guide evidence-based care delivery.
Over several years, the Oncology Clinical Program has established a variety of workgroups designed to standardize care delivery, reduce practice variability, implement national cancer care guidelines, and support quality improvement and clinical collaboration in specific types of cancer. The workgroups include employed and community-based physicians, nurses, clinicians, and data management staff. They are responsible for identifying, implementing, and tracking quality improvement initiatives to ensure patients receive the best cancer treatment possible.
Since the program's inception, several evidence-based initiatives for improving the quality and delivery of cancer care have been introduced with great success. The following are examples of oncology-based quality initiatives that have resulted in improved and more efficient care:
- In 2007, our physician-based breast cancer quality improvement team sought to improve system-wide utilization of sentinel node biopsy, a procedure in which a sentinel lymph node is removed and examined under a microscope to determine whether cancer cells are present. Through improved clinical infrastructure, physician collaboration, and individual physician mentoring, the use of sentinel lymph node biopsies increased from 69.1% to 87.9%.
- In 2008, we worked on improving accuracy in identifying cancer severity (cancer stage) for colon cancer patients undergoing potentially curative colon cancer surgery. According to national guidelines, these patients must have a minimum of 12 lymph nodes removed and evaluated by a clinician in order to be accurately staged. Following system-wide practice standardization, the percentage of cases in which a minimum of 12 lymph nodes were evaluated increased from 78.8% to 95.1%.
- During 2009, two studies were presented at the national Breast Cancer Symposium.
- Information collected in collaboration with the Huntsman Cancer Institute led to three abstracts on endometrial cancer that are being presented at the Society of Gynecologic Oncology in March 2010.
A few of our current projects include:
- Implementation of medical-oncology-specific electronic medical record software for both employed and community-based providers.
- Clinical data collection for renal, brain, ovarian, and melanoma cancer care research.
- Development of standard electronic treatment templates in radiation therapy.
- Evaluation of recently published mammography guidelines and their impact on community health.
- Implementation of safety standards for chemotherapy orders.
- Enhancement of community outreach programs, including cancer screening and survivorship.
The Oncology Clinical Program's effect on improving the delivery of cancer care is growing. The program continues to manage and support projects that enhance cancer care research, quality of patient care, and clinical care processes.