Quality Measures in Primary Care Skin Cancer Management: a Qualitative Study of the Views of Key Informants

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Jul 11

PMID 38991668

Authors

Samantha Spanos

Nehal Singh

Bela I Laginha

Gaston Arnolda

Andrea L Smith

David Wilkinson

Anne E Cust

Jeffrey Braithwaite

Frances Rapport

Affiliations

Soon will be listed here.

Abstract

Objectives: This study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.

Design: Semistructured interviews and qualitative proforma surveys were conducted with skin cancer experts from a range of healthcare settings. Framework analysis was employed to identify key groups of quality measures within the domains of the Donabedian model of healthcare quality (structure, process, outcome). Interview and survey data were triangulated to identify common groups of quality measures, barriers and facilitators.

Participants: We purposively recruited skin cancer experts from Australia and internationally with knowledge and experience in skin cancer management. The final sample consisted of 15 participants who had clinical or academic backgrounds.

Results: Participants unequivocally expressed the need for quality measures to guide skin cancer care. Ten groups of quality measures were identified: three groups related to the structural elements of care (eg, diagnostic tools), four related to the processes of care (eg, diagnostic process) and three related to outcomes of care (eg, treatment outcomes). Implementation barriers included clinician resistance, system inadequacies and external factors (eg, patient risk). Facilitators included incentives, education, agreed and feasible indicators and support and guidance.

Conclusions: To service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement.

References

Watts C, Smith A, Robinson S, Chang C, Goumas C, Schmid H . Australian general practitioners' attitudes and knowledge of sentinel lymph node biopsy in melanoma management. Aust J Gen Pract. 2020; 49(6):355-362. DOI: 10.31128/AJGP-10-19-5138. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Spanos S, Singh N, Laginha B, Arnolda G, Wilkinson D, Smith A . Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol. 2023; 64(2):177-193. PMC: 10952799. DOI: 10.1111/ajd.14023. View

Jobson D, Roffey B, Arnold C, Azzi A, Button-Sloan A, Dawson T . Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study. Australas J Dermatol. 2022; 63(3):344-351. DOI: 10.1111/ajd.13848. View

Olsen C, Green A, Pandeya N, Whiteman D . Trends in Melanoma Incidence Rates in Eight Susceptible Populations through 2015. J Invest Dermatol. 2018; 139(6):1392-1395. DOI: 10.1016/j.jid.2018.12.006. View

Smith A, Watts C, Robinson S, Schmid H, Chang C, Thompson J . GPs' involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study. BJGP Open. 2020; 4(2). PMC: 7330208. DOI: 10.3399/bjgpopen20X101028. View

Rosendahl C, Hansen C, Cameron A, Bourne P, Wilson T, Cook B . Measuring performance in skin cancer practice: the SCARD initiative. Int J Dermatol. 2010; 50(1):44-51. DOI: 10.1111/j.1365-4632.2010.04608.x. View

Donabedian A . The quality of care. How can it be assessed?. JAMA. 1988; 260(12):1743-8. DOI: 10.1001/jama.260.12.1743. View

Renz S, Carrington J, Badger T . Two Strategies for Qualitative Content Analysis: An Intramethod Approach to Triangulation. Qual Health Res. 2018; 28(5):824-831. DOI: 10.1177/1049732317753586. View

10.

Brook R, McGlynn E, Shekelle P . Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care. 2000; 12(4):281-95. DOI: 10.1093/intqhc/12.4.281. View

11.

Staples M, Elwood M, Burton R, Williams J, Marks R, Giles G . Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985. Med J Aust. 2006; 184(1):6-10. DOI: 10.5694/j.1326-5377.2006.tb00086.x. View

12.

Brennan T . Physicians' professional responsibility to improve the quality of care. Acad Med. 2002; 77(10):973-80. DOI: 10.1097/00001888-200210000-00008. View

13.

Gordon L, Shih S, Watts C, Goldsbury D, Green A . The economics of skin cancer prevention with implications for Australia and New Zealand: where are we now?. Public Health Res Pract. 2022; 32(1). DOI: 10.17061/phrp31502119. View

14.

Gale N, Heath G, Cameron E, Rashid S, Redwood S . Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. PMC: 3848812. DOI: 10.1186/1471-2288-13-117. View

15.

Campbell S, Braspenning J, Hutchinson A, Marshall M . Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care. 2002; 11(4):358-64. PMC: 1758017. DOI: 10.1136/qhc.11.4.358. View

16.

Olsen C, Pandeya N, Green A, Ragaini B, Venn A, Whiteman D . Keratinocyte cancer incidence in Australia: a review of population-based incidence trends and estimates of lifetime risk. Public Health Res Pract. 2022; 32(1). DOI: 10.17061/phrp3212203. View

17.

Demes J, Nickerson N, Farand L, Becerril Montekio V, Torres P, Dube J . What are the characteristics of the champion that influence the implementation of quality improvement programs?. Eval Program Plann. 2020; 80:101795. DOI: 10.1016/j.evalprogplan.2020.101795. View

18.

Jones O, Jurascheck L, van Melle M, Hickman S, Burrows N, Hall P . Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open. 2019; 9(8):e027529. PMC: 6707687. DOI: 10.1136/bmjopen-2018-027529. View

19.

Posada E, Lauck K, Tran T, Krause K, Nelson K . Educational Interventions to Support Primary Care Provider Performance of Diagnostic Skin Cancer Examinations: A Systematic Literature Review. J Cancer Educ. 2022; 37(6):1579-1588. PMC: 8763425. DOI: 10.1007/s13187-021-02118-8. View

20.

Salzer M, Nixon C, Schut L, Karver M, Bickman L . Validating quality indicators. Quality as relationship between structure, process, and outcome. Eval Rev. 1997; 21(3):292-309. DOI: 10.1177/0193841X9702100302. View