Clinical Quality Registries: Engaging Effectiveness Data for Quality Improvement

Quality definitions in health care vary; however, the key domains demand that it should be safe, patient-centered, timely, efficient, and equitable.¹ The assessment of quality requires measure of clinical effectiveness and this can in part be reflected by the use of performance indicators.² The identification of inequality and variation in access, process and outcome provides important focus to direct initiatives toward quality improvement.³

Samuel et al.⁴ have reported a thorough and considered evaluation of cancer outcomes (colorectal, lung, and prostate) derived from the Veterans Administration Central Cancer Registry between 2001 and 2004. The study reviewed 20 cancer-related process and outcome measures finding significant differences between ethnic groups. Compared with Whites, Blacks were half as likely to undergo curative surgery for early stage lung cancer (adjusted odds ratio = 0.50; 95% confidence interval = 0.41, 0.60), half as likely to receive appropriate radiotherapy, and significantly less likely to receive appropriate symptom control following chemotherapy. Significant and clinically important disparities were observed for seven of 20 measures of cancer care reported.

This important report highlights several targets for health improvement initiatives, and yet the capacity for these data to drive improvement may be limited. First, the decade-old data may no longer accurately reflect current health care and may be perceived by stakeholders as no longer relevant to current health care delivery. Second, the report describes cancer outcomes within the Veterans Administration, providing important internal benchmarking but little guidance to outcomes generated in alternate care structures such as Medicare and private health systems. Third, the indicator panel was internally generated, nonstandardized, and may differ in structure and content from indicators captured in other health care systems.

Importantly, simply repeating the measurement of performance indicators in lung cancer care in the absence of an implementation strategy to engage the quality improvement cycle may have no positive effect on measures of effectiveness.⁵ Data can, however, be effectively engaged to drive quality improvement through the linkage provided by clinical disease quality registries.⁶

There are emerging models for cancer registry development,⁷ and evaluation of the now mature national Danish Lung Cancer Registry^8,9 confirms substantial ongoing improvement in outcomes, effectiveness, and quality in health care delivery.

The full value of these data may not be realized without regular performance review, rigorous evaluation by clinical and administrative governance, clinical and patient bodies, and the development and implementation of strategies to improve outcomes in areas of need.¹⁰