Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures: An NCCN institutional analysis

Dorothy Romanus, Martin R. Weiser, John M. Skibber, Anna Ter Veer, Joyce C. Niland, John L. Wilson, Ashwani Rajput, Yu Ning Wong, Al B Benson III, Stephen Shibata, Deborah Schrag*

*Corresponding author for this work

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers. Methods: Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers. Results: A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81 %), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers. Conclusions: Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.

Original languageEnglish (US)
Pages (from-to)895-904
Number of pages10
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume7
Issue number8
DOIs
StatePublished - Jan 1 2009

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Colorectal Neoplasms
Guidelines
Neoplasms
Databases
Rectal Neoplasms
Consensus
Treatment Refusal
Guideline Adherence
Adjuvant Chemotherapy
Documentation
Colonic Neoplasms
Therapeutics

Keywords

  • Clinical practice guidelines
  • Colorectal cancer
  • Quality improvement
  • Quality measurement

ASJC Scopus subject areas

  • Oncology

Cite this

Romanus, Dorothy ; Weiser, Martin R. ; Skibber, John M. ; Ter Veer, Anna ; Niland, Joyce C. ; Wilson, John L. ; Rajput, Ashwani ; Wong, Yu Ning ; Benson III, Al B ; Shibata, Stephen ; Schrag, Deborah. / Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures : An NCCN institutional analysis. In: JNCCN Journal of the National Comprehensive Cancer Network. 2009 ; Vol. 7, No. 8. pp. 895-904.
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title = "Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures: An NCCN institutional analysis",
abstract = "Background: The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers. Methods: Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers. Results: A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90{\%}). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81 {\%}), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83{\%}). These low rates of concordance seemed to be consistent across centers. Conclusions: Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.",
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Romanus, D, Weiser, MR, Skibber, JM, Ter Veer, A, Niland, JC, Wilson, JL, Rajput, A, Wong, YN, Benson III, AB, Shibata, S & Schrag, D 2009, 'Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures: An NCCN institutional analysis', JNCCN Journal of the National Comprehensive Cancer Network, vol. 7, no. 8, pp. 895-904. https://doi.org/10.6004/jnccn.2009.0059

Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures : An NCCN institutional analysis. / Romanus, Dorothy; Weiser, Martin R.; Skibber, John M.; Ter Veer, Anna; Niland, Joyce C.; Wilson, John L.; Rajput, Ashwani; Wong, Yu Ning; Benson III, Al B; Shibata, Stephen; Schrag, Deborah.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 7, No. 8, 01.01.2009, p. 895-904.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Concordance with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures

T2 - An NCCN institutional analysis

AU - Romanus, Dorothy

AU - Weiser, Martin R.

AU - Skibber, John M.

AU - Ter Veer, Anna

AU - Niland, Joyce C.

AU - Wilson, John L.

AU - Rajput, Ashwani

AU - Wong, Yu Ning

AU - Benson III, Al B

AU - Shibata, Stephen

AU - Schrag, Deborah

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers. Methods: Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers. Results: A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81 %), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers. Conclusions: Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.

AB - Background: The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers. Methods: Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers. Results: A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81 %), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers. Conclusions: Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.

KW - Clinical practice guidelines

KW - Colorectal cancer

KW - Quality improvement

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