Measuring Progress in Health Care Reform


Over the last couple of years the nation has been talking about how to reform health care. The discussion involves everyone from policymakers to IT experts, patients to doctors, caregivers to executives, and all combinations of the above. Regardless of who is involved however, the themes of the discussion hardly change: Patient-centeredness. Quality. Value. Here at LIVESTRONG we spend a lot of time focused on the first aim, through our programmatic work, our navigation services, and our research agenda to establish survivorship as a critical area for the health care system to improve.

The last two you may be less familiar with. Quality and Value can be very abstract terms ? everyone has heard of them, but they can mean many things. In the context of driving health care improvement however, they both come down to one critical concept: measurement. As the saying goes, ?You can?t manage what you can?t measure.? This is especially true in health care, as there are dozens of moving parts during an individual?s treatment journey for any particular injury or disease.

But cancer is not just another disease ? it is one of the most complicated challenges we?ve faced. And getting better at treating it means seeing if what we are doing is successful or not. One of the biggest challenges in measuring how we treat a disease like cancer is the tendency to look at the science, the pathways, the process, and the immediate outcome. We are still missing the type of cross-cutting measures that matter to patients, such as what needs to happen before treatment, how well symptoms are managed, how effectively we are transitioning patients between different facilities, or what happens after discharge from the hospital or in the months after the final round of therapy. And developing these measures is tough work: it takes time and energy to conduct rounds of validation by professionals scattered around the country, from statisticians to researchers, doctors, administrators and patient advocates.

But there is good news: The American Society of Clinical Oncology (ASCO) has formed a program called the Quality Oncology Practice Initiative, or QOPI. QOPI aims to raise the bar for oncologists by promoting ?a culture of self-examination and improvement? and providing tools and resources to examine all aspects of the care process, including the kind of patient-centered measures that are sorely lacking today. LIVESTRONG attended the Collaborative Cancer Measure Summit last week with experts from all realms of oncology and patient advocacy. The goal of the summit was to outline potential measure areas and compile an action plan for how to get these tools developed and into the hands of the practices who are part of the QOPI program. Two of our staff, Ruth Rechis and Sarah Arvey, attended and presented their ideas based on LIVESTRONG?s research in survivorship.

The next steps for Summit leaders will be to distill this group down into a handful of measure areas and collaborate with other national measurement organizations on final selection. And soon after that, the final list will work its way into various quality improvement programs around the country. All in all, this work is a buildup to putting together the kinds of checklists and processes that ensure we are paying proper attention to the kinds of things that will truly lead us towards a reformed health care system: Quality, Value and Patient-Centeredness.

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