VA-Radiation Oncology Quality Surveillance Program.

Int J Radiat Oncol Biol Phys. 2020 Mar 1;106(3):639-647. doi: 10.1016/j.ijrobp.2019.08.064. Epub 2020 Jan 23.

Hagan M1, Kapoor R2, Michalski J3, Sandler H4, Movsas B5, Chetty I6, Lally B6, Rengan R6, Robinson C6, Rimner A6, Simone C6, Timmerman R6, Zelefsky M7, DeMarco J7, Hamstra D7, Lawton C7, Potters L7, Valicenti R7, Mutic S3, Bosch W3, Abraham C3, Caruthers D3, Brame R3, Palta JR2, Sleeman W8, Nalluri J8.

Author information

1. VHA National Radiation Oncology Program Office, Richmond, Virginia. Electronic address:

2. VHA National Radiation Oncology Program Office, Richmond, Virginia.

3. Washington University in Saint Louis, Saint Louis, Missouri.

4. Cedars-Sinai Medical Center, Los Angeles, California.

5. Henry Ford Health System, Detroit, Michigan.

6. VHA Lung Cancer Blue Ribbon Panel.

7. VHA Prostate Cancer Blue Ribbon Panel.

8. Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.



We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year.


State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy.


Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined.


The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.

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