The Ohio State University, Columbus, OH, USA.
Gynecol Oncol. 2013 Sep;130(3):403-6. doi: 10.1016/j.ygyno.2013.05.026. Epub 2013 May 26.
The Affordable Care Act mandates the Prospective Payment System (PPS)-Exempt Cancer Hospitals Quality Reporting program. These 11 hospitals (which are paid fee-for-service rather than on a DRG system) began reporting measures (2 general safety, 2 breast, 1 colon) in 2013. Given this reporting mandate, we set out to determine whether the PPS-exempt gynecologic oncology programs could identify quality measures specific to the care of our patients.
A list of 12 quality measures specific to gynecologic oncology was created (from sources including the National Quality Forum and the SGO). Measures already in use were not included. The list was ranked by the gynecologic oncology program directors at the PPS-exempt hospitals. Descriptive statistics (including mean and SD for rankings) were utilized.
Despite mandatory reporting of quality measures for PPS-exempt cancer hospitals, little consensus exists regarding specific gynecologic cancer measures. Documentation of debulking status, cancer survival, and offering minimally invasive surgery (for endometrial cancer) and intraperitoneal chemotherapy (for ovarian cancer) are important, but with widely variable responses (when ranked 1-12, standard deviations are 2-3). General issues regarding adherence to guidelines for the use of GCSF, documentation of functional status, and tracking of patient satisfaction scores were ranked the lowest. Three of the directors reported that their compensation is partially linked to quality outcomes.
There is wide variability in ranking of quality measures, and may relate to provider or institutional factors. Despite the mandatory reporting in PPS-exempt cancer hospitals, work remains to define gynecologic cancer quality measures.
平价医疗法案要求前瞻性支付系统（PPS）豁免癌症医院质量报告计划。这 11 家医院（按服务收费，而不是按疾病诊断相关分组系统收费）于 2013 年开始报告措施（2 项一般安全性、2 项乳房、1 项结肠）。鉴于这一报告要求，我们着手确定 PPS 豁免妇科肿瘤学计划是否能够确定针对我们患者护理的具体质量措施。
创建了一份 12 项特定于妇科肿瘤学的质量措施清单（来自包括国家质量论坛和 SGO 在内的来源）。未包括已经在使用的措施。该清单由 PPS 豁免医院的妇科肿瘤学项目主任进行排名。使用描述性统计（包括排名的平均值和标准差）。
尽管对 PPS 豁免癌症医院的质量措施进行了强制性报告，但对于具体的妇科癌症措施几乎没有共识。记录减瘤状态、癌症生存情况以及提供微创手术（用于子宫内膜癌）和腹腔内化疗（用于卵巢癌）很重要，但反应差异很大（排名 1-12 时，标准差为 2-3）。关于遵循 GCSF 使用指南、记录功能状态和跟踪患者满意度评分的一般问题排名最低。三位主任报告说，他们的报酬部分与质量结果挂钩。
质量措施的排名差异很大，可能与提供者或机构因素有关。尽管 PPS 豁免癌症医院进行了强制性报告，但仍需努力定义妇科癌症质量措施。
