Assessment of “Best Practice” Treatment Patterns for a “Radiation Oncology Community Outreach Group” Engaged in Cancer Disparities Outcomes

Objective

Minority patients with cancer have higher recurrence rates than the general population and are more likely to be treated at community centers where the standard of care has been reported to be inferior to that at academic centers. These issues are being explored by Radiation Oncology Community Outreach Group (ROCOG), a consortium of 5 Community Radiation Oncology centers participating in a National Cancer Institute-funded Disparities Grant. As a quality assurance/quality improvement initiative, this study was undertaken to ensure that treatment was at a “best practice” level.

Methods

With the use of the American College of Radiology (ACR) accreditation criteria, an initial self-evaluation was done on 10 randomly selected cases at each of 5 radiation oncology clinics for patients treated between July 2002 and December 2003. The results were analyzed and presented to the centers with recommendations for improvements in April 2004. As part of an application to the ACR for accreditation, a second self-evaluation was performed on randomly selected cases treated between July and December 2004. ACR surveyors conducted the last randomly selected case evaluation.

Results

All centers had acceptable standards at baseline. The ROCOG average compliance rate at first evaluation was 88% vs 92% for ACR-accredited facilities. At reevaluation, the ROCOG average compliance rate was 95% vs 92% (ACR-accredited facilities). At the final evaluation, the ROCOG average compliance rate was 92% vs 90% (ACR-accredited facilities). All 5 sites received ACR accreditation.

Conclusion

Despite a small sample, patients served by these institutions, regardless of minority status, received radiation oncology care at or above the accepted standards. A quality assessment/quality improvement initiative using ACR accreditation to ensure that “best practice” levels led to improved standards. Accreditation is one method that could be used to support a “pay-for-performance” program.

Key Words: Accreditation, American College of Radiology, minority cancer care, quality assurance, quality improvement, quality care, radiation therapy