Measuring Healthcare Organization Characteristics in Cancer Care Delivery Research

National Cancer Institute, Frederick MD

Investigators

Abstract

The characteristics of healthcare organizations—defined as the structures, processes, and organizational level policies—affect cancer care delivery and outcomes at the patient, provider, and system levels. The National Academy of Medicine noted that additional research is needed to understand how healthcare organizational characteristics and processes of care delivery in organizations influence cancer care access, quality, outcomes, and disparities. Several organizational construct frameworks exist to advance such research. However, applying these frameworks and measuring organizational variables in practice can be challenging due to the multilevel and dynamic nature of healthcare, and multifaceted nature of organizational variables. The Compendium of U.S. Health Systems, created as part of the Comparative Health System Performance (CHSP) initiative, was an important step in collating available administrative data on several structural aspects of health systems and their component care delivery organizations. However, several healthcare organizational frameworks point to important organizational structure and process variables that are not available in administrative or claims data and are therefore more challenging to measure. For example, the “healthcare organizational culture and climate” domain from Pina et al.3 includes subdimensions, such as organizational safety climate, justice climate, and organizational readiness for change. These constructs show promise as indicators of organizational performance, yet they may vary substantially over time while also requiring intensive primary data collection via distinct validated assessment tools. Federal care delivery research funders are encouraging multilevel research that includes measurement and intervention on healthcare organizational characteristics; however, there is no compendium of relevant, valid measures for assessing these constructs. One difficulty is that some measures of organizational constructs have only been applied to organizations outside of healthcare. Their relevance to healthcare, and cancer care specifically, is not known. To address the gaps identified above, the technical brief will: • Identify and describe existing healthcare organization structure and process measures relevant to research on the delivery of cancer screening, diagnosis, and treatment; • review the consistency of existing measures (i.e., standardization); • review the usefulness of existing measures that have been developed or validated in healthcare delivery contexts, and their use (if any) in cancer care delivery research; • identify gaps where future measure or method development may be needed to advance multilevel cancer care delivery research; and • identify measures that will be collated into a technical report and an online compendium resource for the cancer care delivery research community. The report will ultimately inform a National Cancer Institute (NCI) funding announcement(s) and supplements that encourage the extramural community to study healthcare organizations and use identified measures. It will also inform NCI-hosted webinars that will educate the research community, as well as an online compendium resource for the cancer care delivery research community.