MRI scans play an important role in prostate cancer care. VA Photo by Brian Hayes

RICHMOND, VA — A study on the VA’s pioneering use of quality metrics in radiation oncology for prostate cancer went into this month’s 2019 American Society for Radiation Oncology Annual Meeting in Chicago preselected as a “Best of ASTRO” presentation that will be presented around the world as a highlight of this year’s advances in radiation oncology.

Three years ago, the VA authorized the project to establish quality metrics to evaluate prostate cancer treatment as it is being delivered. To do that, “we went to professional societies and asked them to stand up site committees for prostate cancer and lung cancer. ASTRO gave us 24 metrics for prostate cancer to be scored as patients were being treated. They are all evidence-based, important outcomes,” said Michael P. Hagan, MD, PhD, VA national director of radiation oncology, Hunter Holmes McGuire VAMC, and professor, Virginia Commonwealth University, both in Richmond, VA.

“This is the first time this information has ever been provided” to oncology providers or quality managers, Hagan told U.S. Medicine. “VA leadership was so impressed with the results that they’ve asked us to apply the process to all cancers in which radiation oncology plays a big part, including those of the head and neck, breast, central nervous system and likely colorectal cancer.”

The evaluation process passively pulls data from the electronic medical record and the radiation oncology treatment management system, so no one has to enter data separately. The system then generates a report card that shows the provider how well the treatment delivered to each patient meets the benchmarks established by the national experts in prostate cancer.

“The idea is that, if you’re treating a patient and you have 24 quality metrics and 36 dosing metrics, all available to you to see how you perform against a national benchmark and other VA practitioners, if you can see those scores day in and day out, you’ll move your practice to where you’ll score better,” Hagan said.

The impact could go well beyond veterans and the VA healthcare system.

“This is the first model for quality assessment in radiation oncology,” Hagan noted. “The fact that it is done passively and is peer reviewed, meaning it can’t be used in a court of law for malpractice, and has anonymized data that can be used by a quality manager to evaluate how clinicians are treating patients makes it interesting to healthcare systems, particularly with Medicare moving to quality reimbursement.”

Given the keen interest in the system and the development of the metrics by national experts, Hagan expects other systems to adopt the quality metrics. “They may become national metrics,” he said.

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