Methodologic approaches to quality care evaluation

A number of problems inherent to quality of care evaluation have been described above. Although issues such as limited resources and clinical staff resistance may not be specific to cancer care, they certainly impact on the evaluation of the quality of care offered to cancer patients. Other issues such as complexity of care and the time span over which care can occur are more applicable to the cancer patient population alone. In response to these issues, I have offered a number of solutions, such as reorganizations of tasks, the use of statistical techniques such as sampling and power analysis, and various feedback mechanisms which have been implemented at MSKCC. The data presented indicate that these mechanisms have been at least partially successful; however, given the absence of a controlled environment, drawing firm conclusions about the relationship between cause and effect is not possible. I hope that in the future these results may be replicated at other institutions who elect to implement any of the suggestions I have made.