Scott Ramsey, MD, PhD
In a groundbreaking study of costs and quality of cancer care among cancer clinics in the state of Washington, investigators found wide disparity in end-of-life care, suggesting that improvements in cost and quality could be attained if treatment centers share information on what works and endeavor to improve. Smaller but also significant differences were noted in measures of care for patients with breast cancer and in the management of chemotherapy in general for breast, colorectal, and lung cancers.
The report is unique because it involved agreement among 27 participating clinics in Washington to publicly disclose findings on comparative costs and quality of cancer care. In some cases the disparities in care and conformance with guidelines were wide. In particular, the report called for improvements in management of emergency department (ED) and inpatient stays, which were high among patients receiving chemotherapy.
Table. Key Comparative Measures for Cancer Clinics in Study
ED indicates emergency department; ER, estrogen receptor; ICU, intensive care unit; PR, progesterone receptor.
aRanges have been risk-standardized for patient factors and clinic size.
bThe measure included patients who had a test for cancer antigen (CA) 15-3, CA 27.29, or carcinoembryonic antigen. These tumor markers have not been proven useful to find breast cancer recurrence or extend life in patients who had early-stage breast cancer.
The study was conducted by the Hutchinson Institute for Cancer Outcomes Research (HICOR), based at Fred Hutchinson Cancer Research Center in Seattle, Washington. The goal behind disclosuring the results was to encourage collaboration to identify ways that practices can improve and initiate change. “I believe strongly that better transparency will ultimately improve care and [hopefully] lower costs for patients,” Scott Ramsey, MD, PhD, director of HICOR, said in a statement.
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