Identifying organization-level features important to patient outcomes in cancer care: qualitative interview results with experts

BACKGROUND: Addressing quality and equity requires understanding organization-level features that affect patient outcomes. Using cancer care as the context, we aimed to identify organization-level features important to patient-level outcomes and assess the feasibility of including them in clinical data warehouses. METHODS: In-depth interviews were conducted with 12 experts, including academicians with expertise in organizational theory and implementation science, oncology practitioners, and clinical data warehouse developers. Members of the research team developed a semi-structured interview guide to identify organization-level features perceived as important to patient outcomes, and the measurability and obtainability of identified features. Interviews were audio-recorded and transcribed verbatim. De-identified transcript data were organized using NVivo 12 and analyzed using thematic analyses. RESULTS: Analysis revealed key organization-level features important to care quality, including leadership structure and culture, quality monitoring processes, external incentives, and support service provision. Respondents highlighted the importance of intentionality to equity, and how many of the same organization features affecting quality also affect equity. Some features were deemed readily knowable, while others presented measurement challenges to extract from existing data resources or to collect de novo. Given their ownership of the data in the US, collaboration with healthcare organizations will be essential for advancing organization-level measurement in the US. CONCLUSIONS: Understanding organization-level features is vital for enhancing care quality and promoting equity in cancer care and otherwise. Leveraging publicly available information and fostering partnerships between healthcare organizations and researchers could facilitate the compilation of relevant data. External incentives and measurement development initiatives could afford further advancement. Findings contribute to the understanding of organization-level determinants of cancer care quality and equity, offering practical avenues for research, data collection, and improved care and outcomes.