Study: Five Distinct Characteristics of High-Value Cancer Care


An investigation into a handful of high-quality, low-spending oncology practice sites offered insight into five specific attributes of high-value cancer care, researchers reported in a study online in JAMA Oncology (doi: 10.1001/jamaoncol.2017.3803).

The following distinctions sharply distinguished high-value oncology practices from other oncology practices, according to the study:

  •       conservative use of imaging,
  •       early discussion of treatment limitations and consequences,
  •       a single point-of-contact (such as a care coordinator) for the patient or family,
  •       maximum use of registered nurses for interventions, and
  •       a large, multicomponent health system, within which the oncology practice “was small and cohesive and retained its distinct identity.”

Researchers came to their findings after conducting 2-day site visits to seven oncology practices in the United States Pacific Northwest and Midwest with relatively low spending and high-quality care. Staff from the practices participated in interviews structured to probe for attributes of high-quality care.

An expert panel selected three attributes as having the highest immediate potential for decreasing spending without sacrificing quality of care: early and normalized palliative care, ambulatory rapid response, and early discussion of treatment limitations and consequences.

“Early introduction of palliative care services and normalizing palliative care—‘this is the way we always do it’—is another high-value attribute,” researchers wrote. “Normalizing palliative care mitigates the sometimes negative connotations of the end-of-life or hospice care associated with palliative care.”


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High-value oncology practices aimed to avoid unnecessary and inconvenient visits to the emergency department for urgent care and instead directed patients to an onsite ambulatory care facility, according to the study.

“The results from our small, hypothesis-generating study are insufficient to support widespread adoption of the attributes that we reported,” researchers wrote. “Our results can be viewed as those from a ‘training’ data set; organizations that choose to implement our findings should carefully study—as a ‘validation’ set—the contribution of our results in achieving better health, quality care, and low cost.”—Jolynn Tumolo