The 2016 edition of the Commission on Cancer’s accreditation standards manual clarifies and provides additional information in many areas and raises the bar for compliance in some, including psychosocial distress screening, survivorship care, data reporting, and activities in prevention and screening.
Cancer Program Standards: Ensuring Patient-Centered Care spells out the criteria cancer programs must meet to receive accreditation by the Commission on Cancer, a quality program of the American College of Surgeons.1 Most of the standards were effective as of January 1, 2016. A few, considered “phase-in standards,” will go into effect at the beginning of 2017.
Variety of Revisions
Many of the changes in the 2016 edition are clarifications and improve consistency in the language, said Nina Miller, Manager of the Commission on Cancer’s Cancer Liaison Initiatives, who presented an overview of the 2016 changes at the Association of Community Cancer Centers (ACCC) Annual Meeting, held recently in Washington, DC. The standards compliance criteria of “every year,” for example, is now phrased as “every calendar year.”
Other updates include a change in emphasis. Each chapter of the manual includes a discussion of definitions and requirements, and they often reflect a more process-oriented approach compared to the preceding edition, which was published in 2012. In general, Ms. Miller said, the new edition is not so much about changing requirements as it is about “changing the flavor,” by emphasizing process. “It is not enough just to have the infrastructure, there must also be formal processes in place as well as monitoring of these processes,” she said in an interview.
The first chapter, for instance, on program management, adds more detail on the roles and requirements of cancer committee members and coordinators (Standard 1.2); meeting attendance (Standard 1.3); and documentation of meetings (Standard 1.4). It stresses the need for an active multidisciplinary team, requiring participation from both medical specialties and nonmedical support and administrative services. It also emphasizes the decision-making authority of the committee and adds information on how and when appropriate cancer program goals should be established (Standard 1.5).
Looking at Results
“This edition focused on removing ambiguity from the standards and including additional information to assist programs with understanding the process requirements,” said Allison Knutson, the Commission on Cancer’s Accreditation and Standards Manager, in an interview. “We wanted to emphasize greater involvement by the cancer committee members and clarify the responsibilities of the various coordinators. We wanted to encourage physician buy-in and engagement. There should be physician champions, representatives of different medical and nonmedical specialties—more than just one or two people taking responsibility for earning accreditation.”
This edition focused on removing ambiguity from the standards and including additional information to assist programs with understanding the process requirements.— Allison Knutson
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Likewise, Monitoring of Prevention, Screening, and Outreach Activities (Standard 1.8) details the specific responsibilities and activities of the community outreach coordinator, which must include monitoring, reporting, and documenting the effectiveness and outcomes of these specific activities. “This is what the standards are all about,” Ms. Miller said. “What is the impact on the participants? Did the screening lead to a diagnosis? Is the follow-up process for positive results functioning properly? Based on results of the analysis, do you need to make changes to events? We want programs to be looking at their results—to close the loop on the prevention and screening events.”
Three standards with changes in requirements have to do with pathology reports, psychosocial distress screening, and survivorship care plans.
Beginning in 2017, 95% of eligible pathology reports must have all the data elements required by the College of American Pathology protocols and must be structured using synoptic reporting (Standard 2.1). The previous criterion for compliance was that 90% of eligible pathology reports contained the required data elements, while programs that met the 95% criterion of reports in synoptic formatting earned a commendation rating.
Psychosocial services coordinators have increased documentation requirements (Standard 3.2). Cancer programs must now evaluate, document, and report on the psychosocial distress screening process each calendar year. This section clarifies and stresses the importance of assessments for individuals with high levels of distress and states that screening conducted only online or by mail without being reviewed at a medical visit do not meet the standard.
Each program’s survivorship care plan process (Standard 3.3) must stipulate patient eligibility, and programs are required to meet the implementation percentages outlined in the manual. An annual report that evaluates the process for care plan delivery is outlined in this standard, which is now consistent with a similar standard required for accreditation by the National Accreditation Program for Breast Centers.
A final revision in this edition refers to the requirement that cancer programs participate in the American College of Surgeon’s Rapid Quality Reporting System, which enables them to report data on patients concurrently and receive notifications of treatment expectations (Standard 5.2). Starting in 2017, Commission on Cancer–accredited programs will have to meet phase-in compliance criteria requiring that they participate in the Rapid Quality Reporting System, previously required only for commendation.
New and updated cases must be submitted at least once each calendar quarter (once a month for commendation). In addition, the Rapid Quality Reporting System data and performance reports must be reviewed by the cancer committee semiannually and the review documented in the minutes.
Cases reported to the Rapid Quality Reporting System eventually go into the National Cancer Data Base, a joint program of the American College of Surgeons and the American Cancer Society that analyzes and tracks cancer patients’ treatments and outcomes nationwide. As such, the quality of its data is of major importance, attesting to the value of standards and accreditation.
“We think this standard is really critical, as the concurrent data review can directly impact the quality of care for individual cancer patients,” said Ms. Miller. “It is at the core of the whole accreditation process.” ■
Disclosure: Ms. Miller and Ms. Knutson reported no potential conflicts of interest.
1. American College of Surgeons Commission on Cancer: Cancer Program Standards: Ensuring Patient-Centered Care, 2016 edition. Available at https://www.facs.org/quality-programs/cancer/coc/standards. Accessed March 24, 2016.