The state of quality indicators in surgical oncology

Ask any clinician ... there isn’t a soul who would disagree. Quality in health care is important. It would also be difficult to find many who would disagree that there is much room for improvement in terms of cancer care quality. The Institute of Medicine’s ‘‘Ensuring Quality Cancer Care’’ highlighted a dearth of information on the quality of cancer care and recommended the development of better measures of the quality of cancer care for use by consumers, providers, and payers [1]. In response to this report, many healthcare stakeholders have worked to develop clinical care guidelines based on evidencebased medicine. However, the question remains: Will widespread implementation of these guidelines assure better care for cancer patients? Recent efforts have focused on the development of quality indicators, which measure processes of care. Quality indicators can be used as proxies to assess the quality of care being provided to patients. Findings of variations across providers may represent areas for improvement. Ideally, problems can be flagged and addressed since quality indicators help care providers better understand and improve performance. Physicians and hospitals would use the measurementfeedback loop to help identify areas for improvement in attempts to continually improve performance. Surgeons may be familiar with quality indictors developed by the Surgical Care Improvement Project (SCIP), which include consensus standards for hospital care which are specific to perioperative processes of care. The National Surgical Quality Improvement Program (NSQIP) has also developed surgery specific measures, evaluating a multitude of patients’ pre-operative risk factors and post-operative outcomes. SCIP measures include the appropriate administration of antibiotics and use of venous thromboembolism prophylaxis in the perioperative period. The Centers for Medicare and Medicaid Services (CMS) has been paying hospitals for reporting compliance with certain SCIP quality measures. In addition to giving hospitals a financial incentive to report the quality of their services, this hospital reporting program provides