Tool designed to advance equitable access to quality cancer care
National Comprehensive Cancer Network’s Health Equity Report Card tool demonstrated high usability for helping health providers and organizations identify and address health care inequities and barriers, according to preliminary findings.
Elevating Cancer Equity — a collaborative effort between NCCN, American Cancer Society Cancer Action Network and National Minority Quality Forum, developed Health Equity Report Card (HERC). A working group subsequently developed updates to the tool.
HERC includes 19 practice assessment and improvement recommendations intended to help providers and organizations identify and eliminate disparity bias in care delivery, address social determinants of health, and overcome systemic barriers to optimal care.
The tool evaluates systems’ equitable practices in terms of community engagement, accessibility of care and social determinants of health, addressing bias in care delivery, and quality and comprehensiveness of care.
In the pilot study, researchers compiled feedback from five leading academic medical centers to determine HERC’s feasibility and usability. According to pre-implementation surveys, three of the five centers expected challenges incorporating the tool, but all five successfully completed a first round of self-scoring and third-party scoring across all domains.
Further assessment is underway regarding HERC’s scoring, feedback mechanisms and effects on cancer care. This includes a separate pilot project in the community cancer center setting.
“Current disparities in cancer outcomes are prevalent and unacceptable,” Taneal D. Carter, MS, MPA, manager of the NCCN Cancer Care Equity Program, told Healio. “We anticipate that HERC is a tool that will help us get closer to equitable access to quality and effective cancer care by eliminating equity in cancer care delivery.”
Healio spoke with Carter about HERC’s performance in the pilot study, the next steps in her research, and how she hopes the tool will improve equity in oncology practice.
Healio: How did you develop this report card?
Carter: In 2020, the NCCN, American Cancer Society Cancer Action Network and National Minority Quality Forum convened the Elevating Cancer Equity working group. It consisted of national experts, representing patients and advocates, caregivers, health care providers, researchers and industry. That group discussed concrete, measurable, actionable ways to overcome inequity in oncology and reduce the disparities in outcomes that result from systemic inequality and bias in access and care delivery. Those ideas became HERC.
The 17 actionable practice recommendations from HERC were refined into an implementation plan, including benchmark metrics, sources of evidence and a scoring methodology, all of which were vetted by oncology administrators and health care providers. It was later expanded by a community oncology working group to include 19 practice recommendations.
Healio: What factors or variables does it assess?
Carter: Some examples include measuring whether community demographics are reflected in practice leadership and if marketing materials use culturally and linguistically appropriate language. Other measures pertain to the use of patient navigators plus staff training to reduce barriers to care, including how to discuss clinical trial options and biomarker testing with all patients.
Healio: How might this tool be able to improve equity in cancer care?
Carter: It will allow medical facilities and health care systems to benchmark where they stand regarding best practices for equitable care and can provide a roadmap for specific areas of improvement as needed. This roadmap can be used to develop improvement strategies.
Healio: Can you summarize the preliminary findings from the pilot study?
Carter: Preliminary findings from the pilot study with five leading academic cancer centers have validated feasibility and applicability of HERC as a tool. All participating institutions felt that HERC would inform changes to practice and policies or reinforce existing practices and policies. Every site strongly agreed or agreed that the performance measures and benchmark metrics evaluated within HERC were acceptable and applicable to institutions as a mechanism to evaluate equitable care delivery.
Healio: What are the next steps planned for the tool’s evolution, expansion and adoption?
Carter: Several steps are underway as we continue to refine HERC as a tool for improving equity in cancer care. That includes additional evaluation of the scoring, feedback received, and how HERC impacts cancer care. We plan to publish full results of the pilot in our academic cancer center sites as well as continue to improve HERC for widespread implementation. There is also a separate pilot project underway in the community cancer care setting, which is funded by the Merck Foundation’s Alliance for Equity in Cancer Care as well as other external funders.
Healio: How could this tool change oncology clinical practice?
Carter: Ultimately, we are looking to enact change that enables all people with cancer everywhere to achieve the best possible outcomes. Access to high-quality cancer care according to the latest evidence-based expert consensus-driven guidelines should be available to everyone. We also want to see fair representation in clinical trials that yield results that are applicable for all people.
References:
- NCCN Cancer Center study demonstrates usability of health equity report card (HERC) tool for driving fair access to care (press release). Available at: https://www.prnewswire.com/news-releases/nccn-cancer-center-study-demonstrates-usability-of-health-equity-report-card-herc-tool-for-driving-fair-access-to-care-302288634.html. Published Oct. 28, 2024. Accessed Nov. 22, 2024..
- National Comprehensive Cancer Network. Health Equity Report Card (HERC). Available at: https://www.nccn.org/docs/default-source/oncology-policy-program/herc-healthcare-abbreviated.pdf.
For more information:
Taneal D. Carter, MS, MPA, can be reached at carter@nccn.org.
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