Projects

Quality Indicator Project

With the enactment of the Basic Act on Cancer Control, the Japanese government established the promotion of the “equalization of cancer care”—ensuring access to high-quality cancer care anywhere in Japan—as a national responsibility. Despite the importance of evaluating the current cancer care to achieve equalization, no standardized methodology has been established. Therefore, we have been developing evaluation indicators and establishing a measurement system for clinical care processes.

Development of Quality Indicators

Since 2007, we have been developing Quality Indicators (QIs) for the assessment of quality of care through research groups funded by the Ministry of Health, Labour and Welfare, and since 2013 through research groups supported by the National Cancer Center Research and Development Fund. QIs are generally classified into three categories: “structure” indicators related to facilities and human resources; “process” indicators, such as adherence to standard care; and “outcome” indicators, including survival rates and length of hospital stay. For continuous monitoring, process indicators are particularly important because they can be rapidly evaluated and improved. Accordingly, our research group has developed process indicators for standard care based on clinical practice guidelines, using the internationally recognized RAND/UCLA Appropriateness Method (modified Delphi method). These QIs have been developed for major cancer sites in Japan, including gastric, lung, liver, breast, and colorectal cancers.

　Reference: Higashi T, Nakamura F, Saruki N, Sobue T. Establishing a quality measurement system for cancer care in Japan. Jpn J Clin Oncol. 　43(3):225–32, 2013. [PubMed]

Since 2013, as QIs have been developed primarily from electronic data, we have designed QIs aligned with the characteristics and content of the available data. Within research groups supported by the National Cancer Center Research and Development Fund, we collaborate with academic societies and other organizations to develop new QI items and revise existing ones. In fiscal year 2025, we developed QIs related to genomic medicine.

Establishment of a Measurement system

To establish a practical measurement system, we have explored multiple approaches. Initially, in order to comprehensively assess a wide range of clinical practices—including reasons for non-adherence to standard treatments—we calculated QIs by extracting data from medical records. However, this approach was extremely labor-intensive and resulted in limited progress in measurement activities.
Therefore, since 2013, as part of the activities of the Cancer Registry Subcommittee of the Council of Prefectural Designated Cancer Care Hospitals, we have collected anonymized, linkable hospital-based cancer registry data and Diagnosis Procedure Combination (DPC) data; consequently, we can measure QIs with reduced burden on participating institutions. The measurements are currently conducted as a project commissioned by the Ministry of Health, Labour and Welfare. After calculating QIs using hospital-based cancer registry and DPC data, we verify reasons for non-adherence to standard treatments.
Institutions that submit hospital-based cancer registry data to the National Cancer Center for nationwide aggregation are eligible to participate in the QI project. In 2021, 649 institutions participated in the project. Participating institutions can receive feedback on their adherence to standard care relative to other institutions; additionally, a collaborative framework enables data use to promote the PDCA cycle in each institution.

Construction and Utilization of Databases linked with Cancer Registry

To develop evidence-based cancer control policies, the construction of appropriate databases using large-scale real-world data is essential. Representative large-scale real-world data related to cancer in Japan include hospital-based cancer registry data and Diagnosis Procedure Combination (DPC) data. The hospital-based cancer registry contains indispensable information for cancer analysis, such as ICD-O-3 codes and cancer stage, while DPC data can comprehensively capture details of medical services.
Therefore, we have been constructing the “Cancer HeAlth SERvices research using DPC database (CHASER-DPC)” by linking hospital-based cancer registry and DPC data. We distribute software that generates an anonymized identifier common to both datasets to participating institutions. The datasets collected from the institutions are integrated as a database. While the primary objective of this initiative is to conduct Quality Indicator (QI) project, we also conduct the following research activities:

• Returning data to participating institutions to promote the PDCA cycle
• Assessing and analyzing the nationwide cancer care delivery system in Japan

In addition, we are exploring the potential for linkage with other data sources to further enhance research opportunities.

Retrospective Studies Using Large-Scale Real-World Data

We conduct health services research, clinical epidemiology, and health economics studies using large-scale real-world data to address clinical questions through retrospective studies and delivering effective and efficient healthcare to clinical practice. These data sources include disease registries (e.g., hospital-based cancer registries and the National Clinical Database), claims databases (e.g., the National Database of Health Insurance Claims [NDB] and Diagnosis Procedure Combination data), and electronic health record databases. We integrate diverse expertise from within and beyond our institute, including medical informatics and public policy, and disseminate data‑driven policy recommendations from an independent, neutral perspective to tackle key challenges in cancer control. Examples of our research activities include:
Nationwide epidemiological research using the NDB to inform cancer care and policy
Research on promoting cancer healthcare policy using a surgical case database
Large-scale data-driven evidence generation for oral health policy and promotion of medical–dental collaboration