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2007 QUALITY STUDIES: The reporting of our Quality Data is a
reflection of St Joseph Hospital's commitment to transparency.
CHEMOTHERAPY
The Chemotherapy study was performed to ensure that inpatient
chemotherapy has remained safe even though most chemotherapy is given in
the outpatient setting. The study documented that in-patient
chemotherapy remains extremely safe and error free.
CT GUIDED NEEDLE BIOPSIES OF LUNG NODULES
The CT Lung Biopsy reports that our accuracy and the safety of needle
biopsies in on par with other reporting institutions, even nationally
recognized Cancer Centers. This is attributed to our Radiologist
performing core needle biopsies with a Pathologist present.
Detailed report
ELECTRONIC QUALITY IMPROVEMENT (e-QuIP) FOR BREAST CANCER
The Breast Cancer document was also an ACOS study and CMS indicator.
Its purpose was to assure that Breast cancer patients are at least
offered appropriate postoperative radiation, hormones or chemotherapy.
This study documented that it is often difficult to obtain that
information since some of the care is delivered out of the Hospital
setting. However, once errors in data were corrected, it appears that we
were well within standards at least in postoperative consults being
obtained. Detailed report
LUNG CANCER TIMEFRAME
The Lung Cancer Timeframes study looked at the time between
presenting symptom to the time of diagnosis, and also the time from
diagnosis to treatment. There were no benchmark data to compare to. It
appears that our times were lengthy, and cooperative efforts are being
made to improve this possible issue. The study did document that stage
by stage survival of our Lung Cancer patients are at least equal to the
National survival statistics. Detailed report
LYMPH NODE COUNTS FROM COLON CANCER RESECTIONS
The Colon cancer report was performed in tandem with the ACOS and is
also one of the CMS Medicare Quality Indicators. The report indicates
that we were falling short of evaluating adequate numbers of lymph nodes
at the time of Surgery. Subsequent Process Improvement by the Pathology
Department has resulted in nearly 100% compliance with the standard as
of Summer 2007. Detailed report
OUTMIGRATION STUDY - PART 2
The Outmigration study documented that in 2005 about 11.6% of all cancer
related activates were performed out of Whatcom County in patients who
had some or all of their care here. About 5.2% of patients received all
of their care out of area. In 2006, this outmigration increased for
surgery but essentially stayed the same for other therapies. The
Hospital Governing Board has committed to a program that will enhance
the patient's care experience. Detailed report
PATHOLOGY
The Pathology Report assures us that key indicators in Pathology
remain of the highest quality. Accuracy of diagnosis by over reads and
outside confirmation remains exemplary. There was also well over 90%
compliance with the proper cancer reporting system.
Detailed report
RADIOLOGY
The Radiology report reported on the excellent quality of mammograms
and the accuracy of Radiologist impressions based on Tumor Board
over-reads. Detailed report
2006 QUALITY STUDIES
ENDOMETRIAL CANCER:
Because of national recommendations that all Endometrial Cancer
patients be referred to GYN Oncologists for surgery for Endometrial
Cancer, we assessed the local outcomes of patients treated in Whatcom
County for Stage 1 cancer. We had superior 5 year survival compared to
national numbers, and our care (surgery and adjuvant treatments) was
within NCCN* guidelines for the vast majority of our patients. Referral
to GYN Oncologists would have had little impact in survival of our
patients. Detailed
report
GASTRO-ESOPHAGEAL CANCERS:
According to NCCN* Guidelines, 87% of patients received recommended
care. However, our community had less patients receiving combined Rad/Chemo
than NCCN recommendations. This can be explained by patient choice and
by advanced age of those patients.
This was our first NCCN* comparison study to look at Staging. During the
study period we had less patients receiving trans-esophageal ultrasound
and PET scans than recommended. TES is not available in this community,
but PET scans are increasingly available so we expect closer compliance
in the future. Detailed
report
MULTIPLE MYELOMA:
A review of a three year period demonstrated that 100% of Myeloma
patients treated locally were treated in compliance with NCCN*
guidelines. The 5-year survival was equivalent to national data.
Detailed report
ONCOLOGY OUTMIGRATION:
There was concern that there was an increase in the number of local
patient who left the community for oncology care. This concern was based
on an increased % of inpatient admissions occurring out of our area. A
5-year review indicated that there was no increase in patients receiving
diagnosis or treatment for all of their care out of area. This number
has run at round 10% for the past 5 years. A more detailed report is
forthcoming, but it appears that for patients who receive all or part of
their care locally, the number of patient “activities” out of area is
less than 5%. Detailed report
ANNUAL PATHOLOGY REVIEW:
90% of patients are staged on the Pathology Report. There was a 100%
agreement between initial and “quality review” for all Tumor Board
cases. There was 100% agreement with the locally made diagnosis and a
secondary “outside” review. These findings document the superior quality
of Pathology in local Oncology care.
* - NCCN is a consortium of the major Cancer Centers in North
America. They have “consensus panels” which have developed
recommendations of care for most cancers using evidence-based medicine.
A Community Hospital would not expect to reach 100% compliance with NCCN
recommendations since those patients who are seen at a Cancer Center are
motivated to follow the Center’s recommendations and are usually healthy
enough to have to recommended treatment.
2005 QUALITY STUDIES
In the past year 8 quality studies were performed and reviewed by the Cancer Committee. In summary, they present a glimpse of the level of quality care provided in this community.
One of the Studies performed this year was recommended by the American College of Surgeons, and 4 of the studies were NCCN comparisons.
The NCCN is an organization of the leading Comprehensive Cancer Centers in the US. They had formed “consensus panels” on the management of specific cancers based on “levels of evidence”. Our ambitious goal was to have 75% of our patients meet NCCN Consensus Panel recommendations. Since patients who seek care at a NCCN facility are looking for aggressive “Mecca” care, and are in good enough health to seek it, it is not expected that a community center would be able to reach 100% compliance with their recommendations.
Colon Cancer
This ACOS driven report’s intent was to evaluate whether adjuvant chemotherapy was provided to Stage III colon Cancer. We had more patients receiving the appropriate therapy than our peers and the regional hospitals.
We also learned that we are now doing a better job in getting accurate data with the Registrar traveling to the Medical Oncology office.
For more details, see report.
Malignant Melanoma
We have a large number of Malignant Melanomas diagnosed each year. We attribute this to receiving information from all the non-hospital pathology reports. For example in 2001 only 13 cases were hospital cases and 66 were non-hospital cases.
In addition we assessed if our practice pattern was in line with NCCN for Clark Level 3-4 Melanoma. Because there is no NCCN predetermined adjuvant therapy, all our patients met criteria in that regard. In our study period, 71/72 patients (98.6%) had appropriate excision margins.
For more details, see
report.
Stage III Non-Small Cell Lung Cancer
The management of Non-Small Cell Lung CA has recently incorporated combined chemotherapy and radiation as a standard of care. In 2003 only 50% of our patients were treated within NCCN Guidelines. Of the non-NCCN patients, all of them did not receive the planned chemotherapy. This group of patients had an average age of 73 while the NCCN patients had an average age of 65. All the literature supports withholding concurrent rad/chemo in elderly and poor performance patients. 70% of the non-NCCN patients did not receive NCCN therapy because of “health reasons” and 30% refused the NCCN therapy.
For more details, see
report.
Stage T2N1 Breast Cancer
This stage of Breast Cancer may require a combination of surgery, chemotherapy, hormone therapy and radiation. To assess how our patients were treated, we compared our results to the national pattern of care as determined by NCCN. 73% of patients had recommended care. The majority of these patients did not receive the recommended chemotherapy. Of those, ¾ patients refused what was recommended.
For more details, see
report.
Pancreas Cancer Treatment
Pancreas Cancer is a highly fatal disease often presenting with advanced cancer. 73% of patients were treated according to the NCCN Guidelines. Of the 6 patients not meeting criteria, 3 of these fell out because they did not have a biopsy because their medical condition was too poor for intervention. In a community setting, a tissue diagnosis is not necessary if no treatment will be given. However our survival data is poor and require further monitoring.
For more details, see
report.
Prostate Cancer Volume and Biopsy
This report was generated by an anecdotal report of minimal cancer seen at biopsy resulting in no cancer seen at Prostatectomy. It looked to see if there were criteria of cancer found at biopsy, which resulted in insignificant cancer. There were multiple definitions of “insignificant cancer” in the literature. Suffice it to say; at least for patients with PSAs over 4.0, even a single core with 1 mm of cancer found could result in a “significant cancer” found at surgery.
In addition the study revealed that 50% more patients in our community were treated with surgery than nationally, and about half the national number were treated with radiation. Only 20% of patients who had surgery had a Radiation Oncology consult before surgery.
For more details, see report.
Radiation Therapy Morbidity
Radiation Therapy can cause acute, or chronic side effects. When a LastWord record lists a radiation complication, it is important to review if the diagnosis is correct and if there could be a better way of delivering radiation in the future. On review, there were no treatment errors, and the side effects listed were the standard expected side effects from curative therapy. This review will be continued on a semi-annual basis.
For more details, see report.
Post Lumpectomy Radiation
As part of a business plan to explore mammosite HDR treatment, a study of the use of what is the “national standard of care”, whole breast radiation post lumpectomy, was performed. In 2004 the % of patients who received whole breast radiation after lumpectomy was 69%. Among Surgeons, the rate ranged from 100% to 60%. Of those not treated with Radiation at St. Joseph, 2 received their treatment in Seattle, most likely receiving “partial Breast Radiation” which is now the subject of a RTOG Clinical Trial that St. Joseph will participate in.
For more details, see report.
Radiology and pathology department quality studies
Radiology reported that their tumor board driven over read for diagnostic accuracy was 96.2 percent. Pathology reports that their accuracy on over reads for inhouse and outside referral showed no systematic quality problems.
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