Cancer program practice profile reports (CP3R) Using Great Plains Health data submitted annually to the National Cancer Data Base, the American College of Surgeons’ Commission on Cancer compiles our CP3R. These reports show performance rates for 23 quality measures from 10 primary sites including breast, colon, rectum, lung, cervix, gastric, ovary, endometrium, bladder and kidney. Below is an explanation of the types of measures monitored. Not included in the chart are measures for which Great Plains Health had no measurable data.
Measure type Measure definition and use
High level of evidence supports the measure, including multiple randomized control trials. These measures can be used for such purposes as public reporting, payment incentive programs and the selection of providers by consumers, health plans, or purchasers. Evidence from experimental studies, not randomized control trials, supports the measure. These are intended for internal monitoring of performance within an organization. Limited evidence exists that supports the measure or the measure is used for informative purposes to accredited programs. These measures can be used to identify the status quo as well as monitor patterns and trends of care in order to guide decision-making and resource allocation.
Accountability
Quality Improvement
Surveillance
Evaluation criteria of measures To be compliant with Standards 4.4 and 4.5, cancer programs must: • Meet the above performance rates either with their Expected Performance Rate (EPR) in CP3R or the upper bound of the 95 pecent confidence interval; or • If the performance rates are below the EPR, cancer programs must establish and implement an action plan that reviews and addresses improving performance. • Great Plains Health is compliant with all Expected Performance Rates.
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