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  • DEcIDE Project

Topic Title

  • Testing Cancer Quality Measures for End of Life Care

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Abstract - Draft

Testing Cancer Quality Measures for End of Life Care

Topic Abstract


While cancer causes more than a half million deaths each year in the United States (US), little is known about the quality of care as patients transition from treatment with a curative intent to end-of-life care. Ongoing work to study the quality of cancer care have focused on initial treatment. Yet prior work on the quality of end-of-life care suggests important deficiencies; many patients with advanced cancer continue to get aggressive chemotherapy as they approach death, and may not receive hospice or other palliative care. Significance

The proposed research will extend our knowledge of the performance of quality measures for cancer care at the end-of-life by testing existing measures with more recent data and in new populations. We will also study the trade-offs of a prospective (i.e., examining the quality of care for someone with a poor prognosis and following them forward in time) versus a retrospective (i.e., looking at the records of people who have died and measuring the quality of care that they received prior to death) approach, and will test new quality indicators for pain control using outpatient pharmacy claims data.

Study Objectives

We will use insurance claims data to measure the quality of care that people with cancer receive at the end-of-life. Specifically, we will:

  1. Provide new information about the performance of "retrospective" measures of the quality of care that people with cancer receive at the end-of-life.
  2. Develop new measures of the quality of care for cancer patients at the end-of-life, with a particular focus on the use of adequate pain treatment.
  3. To compare these "retrospective" and "prospective" approaches to measuring quality at the end-of-life.

We will examine quality indicators for end-of-life cancer care using insurance claims data for Medicare beneficiaries from Pennsylvania and New Jersey who are also covered by a supplemental pharmacy assistance program, and data from cancer registries. Using these data, we will provide further data about the usefulness, feasibility, and meaning of previously developed measures of the quality of care at the end-of-life. We will specifically examine how "retrospective" measures (among patients who have died and then looking backwards at their care) compare with the utilization of these health care services for a "prospective" cohort of cancer patients with a poor prognosis.