11. How do we measure cancer care quality? Risk Assessment Diagnosis Cancer Treatment Screening Palliative Care General population Cancer population Longitudinal care Recurrence Surveillance
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20. Transformative technology #2: Clinical decision support Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance High risk Ave risk / Follow-up of abnormal tests Surveillance colonoscopy ONCWATCH REMINDERS real-time quality performance Cancer screening
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22. Transformative technology #2: Clinical decision support Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance High risk Low risk / Follow-up of abnormal tests Surveillance colonoscopy Physician specialty General internist +/- gastroenterologist +/- surgeon real-time quality performance Cancer screening REMINDERS
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27. Concentration of patients among extended medical staff 73% % of patient received services from extended medical staff 90% % of physician inpatient work at primary hospital 98% 2% >500 2% 48% 50-499 <1% 50% 0-49 Extended medical staff Individual providers Patient panel size
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30. Transformative technology #3: Personal health records Risk Assessment Screening Diagnosis Treatment Surveillance Provider -Oncologist -Radiation therapist -Surgeon -Primary Care -Radiologist -Proceduralist -Primary Care -Primary Care -Oncologist -Surgeon -Radiologist -Proceduralist PHR Palliative care Patient/ caregiver Longitudinal care
49. Transformative technology #2: Clinical decision support Oncwatch Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance High risk Low risk / Follow-up of abnormal tests Surveillance colonoscopy REMINDERS Physician specialty General internist +/- gastroenterologist +/- surgeon real-time feedback Cancer screening
50. Sample sizes 98% 2% >500 2% 48% 50-499 <1% 50% 0-49 Assessment of providers as group (extended medical staff) Assessment of providers as individuals Patient population size
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60. Health care quality improvement or implementation research Poor Quality Health Care Good Quality Poor Quality Good Quality
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63. Quality improvement framework Measurement of Cancer Care Quality Organizations Providers Pathway 1: IMPLEMENTATION Good Poor
71. Medicare Medicaid Private Insurance Uninsured Indiana Network for Patient Care Regenstrief Medical Record System (RMRS) General population Cancer population VA INPC State Registry SPIN Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance
72. Risk Assessment Timely Diagnosis Cancer Treatment Screening Surveillance for Recurrence Genomics Risk of Cancer Death
73.
74. Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance Cancer population SEER (20% US) State Registries (Indiana) VA Cancer registries D A T A S O U R C E VA Medicare Medicaid private insurance Uninsured
75. Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance Cancer population SEER (20% US) State Registries (Indiana) VA Cancer registries D A T A S O U R C E SPIN
76. Transformative technology #3: Personal health records Risk Assessment Screening Diagnosis Treatment Surveillance Patient/ caregiver Provider Provider Provider Provider Provider Follow-up of abnormal tests may be improved by coordination Survivorship care may be improved by coordination Patient/ caregiver Patient/ caregiver PHR Patient/ caregiver Palliative care Patient/ caregiver Longitudinal care
78. Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance General population Cancer population (xx%) R E S E A R C H Q U E S T I O N Genomic risk Health Services Research SEER (20% US) State Registries (Indiana) VA Cancer registries
79.
80.
81.
82. Coordination of care across the continuum Risk Assessment Screening Diagnosis Treatment Surveillance Patient Provider Provider Provider Provider Provider Follow-up of abnormal FOBTs may be improved by coordination Survivorship care may be improved by coordination Patient Patient/ caregiver Patient PHR
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84.
85.
86. Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance General population Cancer population (xx%) R E S E A R C H Q U E S T I O N Genomic risk Health Services Research SEER (20% US) State Registries (Indiana) VA Cancer registries
87. Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance General population Cancer population SEER (20% US) State Registries (Indiana) VA Cancer registries D A T A S O U R C E
88. Unmeasured quality gap Health Care Good Quality Poor Quality Certainty Clinical uncertainty Health Care Quality and Uncertainty
89. How do we measure performance? Risk Assessment Diagnosis Cancer Treatment Screening Recurrence Surveillance General population Cancer population SEER Medicare Longitudinal care State cancer registry Medicaid
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91.
92.
93.
94. Coordination of care across the continuum Risk Assessment Screening Diagnosis Treatment Surveillance Patient/ caregiver Provider Provider Provider Provider Provider Follow-up of abnormal FOBTs may be improved by coordination Survivorship care may be improved by coordination Patient/ caregiver Patient/ caregiver Patient/ caregiver PHR