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Vol.52 No.1 contents | Japanese/English |
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- The 25th Lung Cancer Workshop -
Quality Indicators and the Japanese Lung Cancer Registry
Takahiro Higashi1, Hisao Asamura21Department of Health Policy/Public Health, the University of Tokyo, Japan, 2Department of Thoracic Surgery, National Cancer Center Hospital, Japan
Quality of care has been recognized as a national issue in Japan, particularly in the area of cancer care. The Cancer Control Act of 2006 states that the government should take action to assure quality of care throughout Japan. The Interim Report on the Cancer Control Plan, published in 2010, reviewed current activities and stated the need for a Quality Benchmarking Center to monitor the quality of cancer care using process-of-care quality indicators derived from clinical practice guidelines. Recognizing this national concern, a research project is under way to develop process-of-care quality indicators for 5 major types of cancer in Japan, including lung cancer. The process involved the identification of potential quality indicators and the examination of their validity using the modified Delphi method by a panel of multidisciplinary clinical experts. For lung cancer, this process produced 35 quality indicators covering a broad range of care, including pre-treatment evaluation, surgical treatment, chemotherapy and radiation therapy. Although these quality indicators are designed to be implemented based on medical records, some quality indicators were apparently scorable using data from the Japanese Lung Cancer Registry operated by the Japanese Joint Committee for Lung Cancer Registry. If such usage is possible, systematic quality monitoring and feedback could be provided to the participating facility in order to improve quality of care. Further, feedback on care quality in an individual hospital, without disclosing the information to a third party can be regarded as a benefit of participation. However, detailed examination revealed that 6 out of 7 quality indicators that appeared to be theoretically scorable using registry data examined the presence/absence of the documentation of necessary clinical information in patient medical records. Therefore, for the scores to validly represent quality, we must assume that the existence of information in the examined data sets means that the pertinent documentation is also present in the medical records. Because we do not know whether this assumption is reasonable, we concluded that the current database is insufficient for quality of care monitoring. The current Lung Cancer Registry primarily aims to provide data to determine the TNM staging system, limiting the extent of available information in order to avoid placing an excessive burden on participating institutions. If we are to expand its scope to include quality improvement of lung cancer care in the future, the linking of data with other systems such as administrative databases and hospital-based cancer registries may be necessary.
key words: Quality of care, Lung cancer registry, Quality improvement, Quality indicator, Modified-Delphi method
JJLC 52 (1): 72-76, 2012
