The proposed study will compare the quality of care for colorectal cancer among Medicare managed care plans and fee-for-service care, among individual hospitals, and by hospital and patient characteristics using data from the California Cancer Registry (CCR) and a survey of recently diagnosed patients. The study has three specific aims: 1. To evaluate the accuracy of CCR treatment data through a physician survey; 2. To assess quality of care using performances measures derived from CCR data, including stage of diagnosis, timeliness of care, adherence to treatment guidelines, and survival; and 3. To assess quality of care, using measures that are best derived from a patient survey, including over all impressions of care, access to care, provision of information and education, and coordination of care.
The first aim will focus on a sample of 2,200 patients for whom national guidelines recommend adjuvant therapy. In the second aim, advance statistical methods will be used to analyze 70,000 patients diagnosed over five years. CCR records will be linked to Medical Care enrollment files to identify specific health plans and fee-for-service care for patients 65 and older; CCR data will also be linked to hospital discharge abstracts and U.S. census data for all patients to gain added information for risk adjustment. For the third aim, 2,000 patients will be surveyed within three to six months of diagnosis to obtain their personal appraisals of care. The study seeks to provide new information and multiple measures of quality of care for colorectal cancer within health plans and in hospitals and for patients in different sociodemographic groups. By doing so the study hopes to foster public reporting of risk-adjusted quality measures for health plans or providers, bench marking standards for internal quality improvement by health plans and providers, and standardized surveys to monitor patients' appraisals of care, thereby providing a model for new uses of cancer registries to assess the quality of cancer care.
