Abstract
Purpose: The University of Kentucky Markey Cancer Center Affiliate Network (MCCAN) increased access to high-quality cancer care for patients treated in community hospitals across the state by leveraging the American College of Surgeons Commission on Cancer (CoC) standards to improve quality among its member sites. This study describes the network activities and services identified as most helpful or effective to its members, as well as the perceived value of joining MCCAN or pursing accreditation. Methods: An independent research team conducted in-depth, semistructured interviews with 18 administrators and clinicians from 10 MCCAN hospitals in 2019. Interviews were transcribed and a thematic analysis was conducted. Findings: Network affiliation and CoC accreditation were perceived as helpful to improving quality of care. Having both clinician and administrative champions were key facilitators to achieving CoC standards and made mentoring of member sites a critical activity of the Network. Other components identified as valuable and/or key to the Network's success included providing access to specific CoC-required clinical services (eg, genetic counseling); offering regular performance monitoring and individualized feedback; establishing a culture of quality improvement; and fostering trust within the Network with patient referrals (ie, sending patients back to their local hospital for ongoing care). Conclusions: Quality improvement in community cancer programs is challenging but several strategies were identified by members as valuable and effective. Efforts to disseminate the MCCAN model should focus on identifying the needs of community hospitals, implementing a quality monitoring system, and fostering site-level champions who can be influential drivers of change.
| Original language | English |
|---|---|
| Pages (from-to) | 827-837 |
| Number of pages | 11 |
| Journal | Journal of Rural Health |
| Volume | 38 |
| Issue number | 4 |
| DOIs | |
| State | Published - Sep 1 2022 |
Bibliographical note
Publisher Copyright:© 2021 National Rural Health Association.
Funding
MCCAN staff facilitated the construction of a purposive sample of cancer clinicians, nursing staff, and administrators from community hospitals attending the annual MCCAN Cancer Care Conference (October 9-10, 2019, in Lexington, Kentucky). Sampling was designed to acquire a spectrum of perspectives with respect to role in the hospital, CoC accreditation status, hospital rurality, location (Appalachian vs not, as defined by the Appalachia Regional Commission), bed size, and annual number of analytic cancer cases (ie, patients who were diagnosed and/or received initial treatment at that facility). Rurality was defined by the Rural Urban Continuum Code (RUCC) associated with the county where the hospital is located, following the categories outlined by the Division of Cancer Control and Population Sciences at the National Cancer Institute.24 Metro counties (RUCC 1-3) include areas designated by the Office of Management and Budget as Metropolitan Statistical Areas. Rural areas include nonmetro counties (RUCC 4-9) and are further categorized as large nonmetro (RUCC 4-6) and rural nonmetro (RUCC 7-9). Potential subjects were sent an email describing the study and inviting them to be interviewed. For those who agreed, an in-person, one-on-one interview was scheduled with 1 of 4 study team members during scheduled conference breaks. Additionally, on-site group interviews with 2-3 participants comprising cancer clinicians, nursing staff, and administrators were scheduled at 3 MCCAN hospitals on October 11, 2019. Study team members were from an outside institution and not affiliated with UK or MCCAN. Development of the interview guide was informed by Roger's Diffusion of Innovation Theory.25 This theory describes the attributes of an innovation that affect the speed and extent of its adoption, which, in the context of this study, are characteristics of the MCCAN model and approach that facilitated or hindered quality improvement and membership in the Network. The interview guide included open-ended questions with probes for clarification for the following topics: motivation and barriers to joining MCCAN, perceived value of membership, and attitudes and perceived value of CoC accreditation (Figure 1). Three interviewers (1 PhD and 2 MDs) were trained by, and worked closely with, the fourth interviewer, the study's Principal Investigator (PhD) who received formal training and has years of experience conducting qualitative research. Interviews were audio-recorded and transcribed verbatim. Subjects were provided $30 in compensation for participation and assured confidentiality. This study was approved by our Institutional Review Board. Interview guide for MCCAN affiliate members. A thematic approach was used to provide insight into participants’ thought processes and meanings.26 Initial codes were generated by the team leader for the key areas of study, specifically Network membership and CoC accreditation standards. Multiple coding was used to compare and group sections of text into specific categories.27 Coding involved 3 team members bringing their own observations and descriptions to team meetings for discussions about similarities, differences, and patterns within and between codes. Overall, there were high levels of agreement across team members. Differing opinions were brought to consensus through collective reflection and meshing of interpretations. Through this process, codes were adapted, redefined, incorporated, and dropped until team members agreed they reached a list of codes that most reflected shared interpretations of participant experiences. Themes were extracted from the codes within each area of study. A summary of key CoC standards evaluated is included in Table 2. Abbreviation: CoC, Commission on Cancer.
| Funders | Funder number |
|---|---|
| American College of Surgeons Commission on Cancer | |
| National Childhood Cancer Registry – National Cancer Institute | T32CA148062 |
| Appalachian Regional Commission |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
-
SDG 3 Good Health and Well-being
Keywords
- cancer care facilities
- health care quality assurance
- intersectoral collaboration
- quality improvement
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
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