Medical Staff Pulse Newsletter

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CME Newsletter - March 2014 (PDF)


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Panel Aims to Ensure Appropriate Cancer Care

Since its launch in January 2012, the Cancer Quality Committee (CQC) has provided leadership and oversight of the quality of clinical care, safety and satisfaction for patients with cancer.

After the Dartmouth Atlas Report identified Cedars-Sinai as an outlier in several cancer metrics, the committee's work became more challenging and fell under more public scrutiny as the healthcare environment focuses on quality and value in cancer care.

Cancer Quality Goals and Initiatives

For 2014, the CQC's goals include:

  • Reducing chemotherapy within 14 days of end of life
  • Reducing ICU admissions of cancer inpatients during the last 30 days of life
  • Reviewing preventable medication errors
  • Increasing accuracy and compliance regarding response evaluation criteria in solid tumors
  • Monitoring the evidence-based, national quality metrics adopted by each cancer program

Zuri Akida Murrell, MD

Vice Chair 
Beth Y. Karlan, MD

About the Committee

The Cancer Quality Committee is a subcommittee of the Cancer Committee. It is made up of cancer program leadership as well as representatives from Medical Affairs, Imaging, Pathology, Pharmacy Services, the Cancer Registry, the Department of Nursing and administration.

Its chair is Zuri Akida Murrell, MD, director of the Cedars-Sinai Colorectal Cancer Center. He is also vice chair of the Cancer Committee.

The Cancer Committee chair and vice chair of the Cancer Quality Committee is Beth Y. Karlan, MD, director of the Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, director of the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology, and director of the Gilda Radner Hereditary Cancer Program.

Most recently, the CQC in collaboration with Cedars-Sinai Pharmacy Services has led efforts to require patient performance status be evaluated and documented based on criteria of the Eastern Cooperative Oncology Group (ECOG) for all chemotherapy orders. This helps assess the appropriateness of chemotherapy for each patient.

It is recommended that cancer therapy not be administered for solid-tumor patients with all of these characteristics:

  • Poor performance status (3 or 4 on the ECOG scale)
  • No benefit from prior evidence-based interventions
  • Not eligible for a clinical trial
  • No strong evidence supporting the clinical value of further anti-cancer treatment

This recommendation is consistent with the Choosing Wisely® initiative — a program of 120 evidence-based recommendations from the American Board of Internal Medicine Foundation — and with the number one recommendation of the American Society of Clinical Oncology.

Physician Education Letters

The CQC reviews cases of patients who either received chemotherapy in the last 14 days of life or had an ICU admission during the last 30 days of life. For cases that the committee agrees are outliers of the National Quality Forum metrics, educational letters are sent to all physicians involved in the care of these cancer inpatients and to their department chairs.

The first six months are educational and don't go onto the physician's file. Repeat offenders are sent to medical staff peer review. The committee offers physicians the opportunity to respond to the letters.

"These quality metrics are being studied at hospitals across the nation, and we are being evaluated against other hospitals," said Zuri Akida Murrell, MD, chair of the CQC. "Soon they could become publicly available at the physician level. The successful implementation of these initiatives to meet these quality metrics will help us not only increase quality of care for our patients but will reflect our superior care in our physician report card when it becomes available."

If you have questions regarding the Cancer Quality Committee or would like to become involved, contact Murrell or Beth Karlan, MD, vice chair, at 310-423-8051 or cynthia.chavira@cshs.org.