Quality indicators in lung cancer: a review and analysis

Internationally, numerous clinical practice guidelines (CPGs) have been developed in order to provide a framework for evidence-based best practice care to guide clinician decision-making.1 How CPGs and other standard of care are implemented into daily practice needs to be measured to be able to identify areas for quality improvement and address barriers to care, to ensure the delivery of high-quality care. Structure measures reflect the attributes of the whole service, process measures reflect what happens to the patient during care and outcome measures what the effects or end result of care provided to the patient.2 These data were analysed and synthesised using previously published characteristics for ideal QIs including method of development or selection process of indicator, measurability and potential to discriminate or detect differences (table 1).3 5–8 An analysis of QIs classified an indicator as meeting all characteristics in a minimum set of desirable characteristics for QIs or not. Validity and reliability, sensitivity and specificity, and relevance depend on the population being studied and type of data collected, so could not be assessed in our study.Table 1 Characteristics of ideal quality indicators* Characteristics Explanation Well defined Explicitly defined inclusion and exclusion criteria Specific Few false positives Sensitive Few false negatives Valid Robust selection process or development Reliable Minimal interobserver or intraobserver variability Able to discriminate Ability to detect variation or change for comparisons Based on evidence and clinically relevant An acceptable identifiable event for user Feasible or measurable Can be measured with data that are available *From Mainz and Campbell et al.3 5 Results Search results A literature Medline search resulted in 75 abstracts. The remaining indicators measured screening or early detection (n=3, 1.0%), general pretreatment assessment (n=3, 1.0%), preoperative assessment (n=22, 7.2%), non-specific treatment (n=11, 3.6%), general outcomes (n=8, 2.6%), prevention (n=1, 0.3%) and follow-up (n=8, 2.6%).Table 2 Types of quality indicators for lung cancer Management continuum of care in lung cancer All QIs assessed (n, %) Prevention Prevention 1 (0.3) Screening Screening or early detection 3 (1.0) Diagnosis Diagnosis 21 (6.9) Staging Staging 18 (5.9) Pretreatment assessment General pretreatment assessment 4 (1.3) Preoperative assessment 22 (7.2) Treatment Surgery 71 (23.4) Systemic ther