The Impact of Structure on Quality of Breast Cancer Care
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Quality of health care is usually conceptualized in terms of the structure of care (e.g., setting, financial and organizational arrangements), process of care (e.g. education, diagnosis and treatment), and outcomes of care (e.g. survival, recurrence, quality of life). Understanding how structure impacts processes and outcomes is vital to quality improvement efforts, yet little is known about the structure of care for patients with breast cancer. The study of structure is necessary to understand how well the health care system is meeting the needs of breast cancer patients, to distinguish the types of medical organizations that deliver adequate and optimal care from those that do not, and to distinguish groups of patients who systematically do and do not receive adequate and optimal support from their health care organizations.
 
 
 
 
 
 
 
 The goal of this study is to understand how the different structural aspects of care impact the quality of care for breast cancer patients. The findings of this work will help policymakers, healthcare organizations, providers and patients to understand ways in which structure of care influences processes and outcomes, identify barriers to optimal care delivery and will result in recommendations about how to eliminate those barriers and most effectively target quality improvement interventions.
 
 
 
 
 
 
 
 With input from patients and providers in the community, we will develop a valid survey to collect data about the structure of care for breast cancer from individuals at three levels of the healthcare system responsible for providing care: the medical office, the medical group, and the health insurance plan. Topics will include financial incentives and organizational policies that support patients, providers, and coordination of care. Data about the structure of care will be merged with patient data about baseline characteristics, treatments, and outcomes 14 months after diagnosis for a cohort of newly diagnosed breast cancer patients (enrolled in an ongoing study of breast cancer care), and analyzed to learn what aspects of structure enhance or diminish the quality of care that patients receive.
 
 
 
 
 
 
 
 Although the medical marketplace has begun to recognize that consumers demand quality, many healthcare organizations remain focused on strategies to contain costs. Previous studies examining structure and the quality of care have tended to measure structure very broadly (e.g., comparing fee-for-service to managed care). Few have addressed the effects of the many new, complex arrangements on quality, particularly in the context care for breast cancer. Without more precise and detailed information, the ability of policymakers and organizations to design and implement effective quality improvement interventions is severely compromised. The strengths of our study design include: 1) development of a survey based on previous research and the input of community patient and physician advisors to address specific details of structure for breast cancer care; 2) measurement of structural characteristics at not just one, but three important organizational levels of healthcare delivery: the actual provider's office, the medical group, and the health plan; and 3) data collection from multiple physician specialties essential to high quality breast cancer care (oncologists, radiation therapists, surgeons, primary care). These findings will provide a comprehensive view of the quality of care for women with breast cancer and inform policymakers about opportunities for interventions to improve the quality of care and outcomes for breast cancer patients.