The expanding use of Electronic Medical Records (EMR) makes it possible to 1) examine practice variation in applying standard guidelines, 2) to precisely determine areas of high and low performance, 3) to determine the relation of practice variation to differences in medical outcomes and utilization, and 4) to feed this information back to improve the quality of care. This study will use the Prevention Index (PI) methodology and the Cancer Research Network (CRN) Virtual Data Warehouse (VDW) to develop and apply a set of Cancer Prevention Indices (CPI) to assess the quality of primary, secondary, and tertiary preventive care for cancer. These CPI measures determine the variations in application by clinicians and health systems of evidence-based guidelines. The indices are based on EMR data and include quality measures for individual services, for groups of services (subscales) and a combined score that summarizes the overall quality of care in participating health care systems. We will: 1) identify retrospectively the variation in CPI scores across clinics and clinical practices and determine the association of these variations to selected event rates several years later. These event rates will include primary prevention (smoking and obesity rates), secondary prevention events (stage at diagnosis of new cancers) and tertiary prevention events (stage at diagnosis of seco'nd primary cancers and recurrences) if numbers permit. The epidemiological component of the study uses a retrospective-prospective design to determine the association of clinician adherence to guidelines to subsequent events among their patients. The intervention component of the study will analyze performance scores for primary care practices in each health care system and provide personalized feedback on performance variation at the system, clinic, and clinician levels to system and clinic managers. The emphasis will be on identifying system problems that can be remedied easily and at reasonable cost. Using a randomized clinical trial design, we will then determine if such feedback leads to changes in care delivery and reductions in performance problems. Finally, we will provide assistance and consultation to systems that would like to use this methodology to monitor future quality of care. Twelve months after the end of the intervention trial, we will repeat the analyses to determine the persistence of intervention effects in the involved systems and assess the degree to which the methods have been adopted.
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