Developing electronic clinical quality measures to assess the cancer diagnostic process

Area of Science:

• Oncology
• Health Informatics
• Quality Improvement

Background:

• Diagnostic performance measures in cancer care are currently underdeveloped.
• Electronic clinical quality measures (eCQMs) offer a potential solution for quantifying and enhancing cancer diagnostic quality.

Purpose of the Study:

• To develop and implement two eCQMs for assessing the diagnostic evaluation of red-flag findings in colorectal cancer (CRC) and lung cancer.
• To quantify the rates of appropriate follow-up for these red-flag findings using electronic health record data.

Main Methods:

• Developed eCQMs for CRC (based on abnormal stool tests or iron deficiency anemia labs) and lung cancer (based on abnormal chest imaging).
• Utilized electronic health record data from two large healthcare systems to identify abnormal results, appropriate follow-up, and necessary exclusions.
• Conducted clinician reviews of selected patient records to validate eCQM accuracy and categorize reasons for missed diagnostic opportunities.

Main Results:

• The CRC eCQM was implemented at both sites, showing appropriate follow-up rates of 36.0% (VA) and 41.1% (Geisinger).
• The lung cancer eCQM was implemented at the VA, with an appropriate evaluation rate of 61.5%.
• Provider factors were most frequently cited as reasons for missed diagnostic opportunities (84/157 cases).

Conclusions:

• Two eCQMs were successfully implemented to evaluate the diagnostic process for colorectal and lung cancer.
• These eCQMs provide a valuable tool for healthcare organizations to monitor and improve cancer diagnostic performance.