Using Quality Indicators Can Improve Outcomes among Patients with Renal Cell Carcinoma

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An expert panel of 13 urologic and medical oncologists worked together to identify 23 quality indicators for renal cell carcinoma, as described in an article in the Journal of Oncology Practice. “These 23 [quality indicators] will provide a means of evaluating the quality of [renal cell carcinoma] care in an effort to improve outcomes in patients. The next step will be to establish a means of measuring each [quality indicator] based on defined or yet-to- be-defined benchmarks,” the authors stated.

The investigators used a modified Delphi technique to select quality indicators that they deemed relevant and practical to renal cell carcinoma care. “Delphi methodology is commonly used when sufficient evidence is available from which to derive indicators but requires review and deliberation by experts,” they explained. The panel members were considered experts in the field of kidney cancer through their clinical work, research, and participation in the annual Canadian Kidney Forum.

A literature search revealed 233 relevant citations. From these, 34 possible quality indicators were identified. Another 24 potential quality indicators were suggested by panel members during a three-round review process. The final set of 23 quality indicators was distributed across the disease spectrum of renal cell carcinoma. Examples include the proportions of patients undergoing appropriate risk-specific staging, with positive margins after partial nephrectomy, with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy, and with metastatic renal cell carcinoma referred to palliative care before death.

“Our future research will define ideal rates of delivery and appropriate benchmarks,” the authors wrote. “Certain indicators are easily measured via administrative data. However, others will require different approaches such as medical record review or patient/caregiver interview. Once benchmarks are established, periodic assessments can measure performance, and strategies can be implemented to improve domains of care in specific jurisdictions as needed. A parallel initiative that will enrich this exercise is the development of a national kidney cancer database (Canadian Kidney Cancer Information System), which has been activated at several centers with point-of-care data entry.” ■

Wood L, et al: J Oncol Pract. June 4, 2013 (early release online).




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