ReCAP: Assessing the Quality of a Radiation Oncology Case-based Peer-review Program in an Integrated Academic and Community Cancer Center Network [Focus on Quality]

QUESTION ASKED:

How can academic centers assess the quality of a comprehensive peer-review program in an integrated academic and community cancer center network?

SUMMARY ANSWER:

Of a total of 104 peer-reviewed cases from four community cancer network centers that were quality audited by expert academic faculty, 17% (18/104) of cases were not concordant with any of the following: national standards, MD Anderson Cancer Center institutional guidelines, or expert review of individual case variations (Figure 1). Deficiencies included incomplete staging work-up, incorrect target and normal tissue delineation, and non-adherence to accepted dose-volume constraints.

METHODS:

An electronic tool was used by community cancer network centers to enter clinical treatment information on patients undergoing peer-review, and at least 10% of the case-load for each community radiation oncology physician was selected for quality audit. Quality metrics included review of the management plan, technical plan, and other indicators.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

Data from only four of 13 current community network sites were available for this analysis. Since quality auditing was conducted on a retrospective sampling of cases, sampling error could result in either a higher or lower non-concordance rate. Although a primary goal of the quality audit program is to educate community network physicians and improve the level of care for future cases, longitudinal assessment of changes in physician treatment plans based on previous feedback is not yet available. Finally, most quality metrics assessed in this study are process metrics, and future efforts will require incorporation of outcomes and cost measurement.

REAL-LIFE IMPLICATIONS:

Given the high rate of non-concordance in the integrated community network, prospective pre-radiotherapy peer review of all cases, in particular expert case review of low-volume or complex disease sites, is recommended. An integrated approach to peer review may help improve the quality, safety, and value of cancer therapy in the community setting.

FIG 1.

Non-concordance rates of peer-reviewed cases, stratified by disease site. Rates represent the number of non-concordant cases divided by the number of peer-reviewed cases in that disease site.

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