- A critical part of understanding the quality of medical care across the cancer continuum is understanding the key characteristics of organizations that deliver care while taking into consideration the multilevel nature of health care delivery. Organizational characteristics can influence patient care-seeking behaviors, access to care, provider decision-making, patient and provider experience, quality of care, and disparities in care.1 It is therefore critical to understand organizational characteristics when designing and disseminating multilevel interventions.
- To advance research investigating the relationship between organizational characteristics and cancer care delivery, Weaver, Breslau, and colleagues developed an Integrated Framework that incorporated organizational characteristics from prominently cited frameworks, systematic reviews, and feedback from collaborators. Our systematic analysis of 17 relevant frameworks supports the comprehensiveness of the Integrated Framework in terms of key organizational context and process characteristics. A few characteristics (e.g., accessibility, readiness for change, past experience with change, absorptive capacity, and complexity) were found in more than one other framework but were not explicitly included in the Integrated Framework.
- Ninety studies employed different approaches (i.e., topics, data/analysis types, and study designs) for describing, measuring, and evaluating organizational characteristics within the context of cancer care delivery research, mostly focusing on screening or treatment, while using a wide variety of study designs and both qualitative and quantitative data.
- The most common study themes included: implementation of quality improvement projects and investigation of context and process barriers to implementation; evaluation of total care models such as patient-centered medical homes; or structural and resource related characteristics such as size, type, affiliation, or characteristics of the patient population.
- Fewer studies considered important organizational concepts such as leadership, psychological states and traits among organization members (e.g., burnout) and groups (e.g., team cohesion), team composition, organizational design, or organizational readiness.
- Twenty-five studies directly tested associations of specific healthcare organizational context, process characteristics, and delivery of cancer care with association of measurement of organizational phenomena; studies mostly had prospective or retrospective cohort designs and assessed organization- or unit-level outcomes (e.g., percent compliance with guideline) rather than patient-level outcomes (e.g., screened/not).
- Screening-related studies mostly focused on total care models and were largely conducted in general medical settings (i.e., not cancer-specific).
- Treatment-related studies covered a variety of settings, themes, and cancer types.
- Few studies examined diagnostics or diagnostic outcomes, such as breast cancer diagnosis quality measures for use of needle/core biopsy.
- Studies that examined the relationship between organizational characteristics and cancer screening, diagnosis, and/or treatment tended to focus on less complex characteristics, such as size, participation in a specific type of health insurance payment program, or patient population demographics, with few studies examining more complicated characteristics such as organizational teamwork, provider attitudes and traits, or centralization (e.g., consolidation of authority or patient volume).
- Studies had little standardization of measures of organizational characteristics that might be considered high-quality (e.g., measured using validated scales).
Objectives. This Technical Brief aims to identify: 1) frameworks that describe organizational context and process characteristics relevant to cancer care delivery research, and compare these frameworks to the Integrated Framework recently developed by National Cancer Institute staff Weaver, Breslau, and colleagues; 2) approaches used to improve understanding of how organizational characteristics are described, measured, and analyzed in the context of cancer screening, diagnosis, or treatment; and 3) organizational context and process characteristics examined in studies assessing cancer care; and 4) evidence gaps and future research needs to advance the science of assessing the effects of organizational characteristics on cancer care.
Review methods. We integrated discussions with Key Informants and syntheses of evidence from searches of literature published from 2010 to 2023, using PubMed, CINAHL, SCOPUS, PsycINFO, and the Cochrane Central Register of Controlled Trials, as well as select grey literature.
Findings. We identified 17 frameworks that were developed or applied to examine the effects of organizational characteristics (including structures, context, and processes) on cancer care delivery. Our analysis of these frameworks supported the comprehensiveness of the Integrated Framework, though a few identified characteristics were not explicitly included in the Integrated Framework. We found 90 studies that take various approaches to describe, measure, and analyze organizational characteristics in the context of cancer care research. Of these, we identified 25 that tested associations between organization characteristics and screening, diagnosis, or treatment outcomes, and described measurement in detail. Cancer-related studies that include organizational measures have used a wide range of study designs and focused mostly on structural characteristics (e.g., type, size), total care models such as the patient-centered medical home, and processes of improvement project implementation and barrier assessment (such as guideline implementation). We identified specific organizational measures examined in the cancer care literature, noting little standardization of measures across studies and a need for multilevel inquiry. Our discussions with Key Informants and review of the literature indicated that many characteristics of healthcare organizations are relevant to cancer care delivery and useful to assess when precisely defined. Studies with stronger designs and more rigorous organizational measurement are needed to better determine the effects of organizational characteristics on the outcomes of cancer care.
Conclusion. Our findings suggest that the Integrated Framework generally covers relevant organizational context and process characteristics. The literature has a wide array of studies examining organizational characteristics, but few studies directly associate organizational factors with clinical outcomes. Research and collaboration are needed to improve measurement of organizational factors, to clarify our understanding of multilevel aspects of organizational context and process and how they affect care, and to standardize terminology and measures.
Marsteller JA, Dukhanin V, Kang SY, Russell LE, Vass M, Zhang A, Sharma R, Bass EB, Snyder C. Measuring Healthcare Organization Characteristics in Cancer Care Delivery Research. Technical Brief No. 43. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003.) AHRQ Publication No. 23-EHC025. Rockville, MD: Agency for Healthcare Research and Quality; June 2023. DOI: www.doi.org/10.23970/AHRQEPCTB43. Posted final reports are located on the Effective Health Care Program search page.