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Using Health Systems to Study and Improve the Quality of Cancer Care

Principal Investigator: Dr. Edward H. Wagner, MD, MPH
Director and Senior Investigator, MacColl Institute for Healthcare Innovation
Group Health Research Institute
Seattle, WA 98101

What's the problem?

The NIH Roadmap and National Cancer Institute strategic plans repeatedly emphasize the importance of involving health care systems in research. Integrated care delivery systems can address key research questions that cannot be answered in other types of settings. Research in this setting can lead to essential insights about the quality of care, including the quality of cancer care and how best to improve patient outcomes.

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How has this research addressed the problem?

Understanding how individual, provider, system, and treatment factors affect the quality of care in community-based health care systems, and then translating those findings into improved clinical practice has been a hallmark of Dr. Wagner's long and distinguished career. He is widely known for developing and disseminating the Chronic Care Model, an evidence-based framework for delivering chronic disease care. Other research interests include the development and testing of population-based care models for the frail elderly and those with cancer, diabetes, and other chronic illnesses; the evaluation of the health and cost impacts of cancer and other chronic disease interventions; and interventions to prevent disability and reduce depressive symptoms in older adults.

Since 1999, Dr. Wagner has been Principal Investigator of the Cancer Research Network (CRN), a cooperative agreement grant sponsored by ARP. The CRN conducts a program of research that spans epidemiology, prevention and health promotion, health care delivery, health communications and medical decision making, psychosocial factors, and burden of disease. The CRN consists of 14 research centers, affiliated with HMOs that provide care for 11 million individuals. Current CRN activities and past accomplishments, including ongoing research projects, funded affiliated grants, and more than 200 research publications, are detailed at

A key element of the CRN's research approach is collaborative, multidisciplinary work, including collaborations with non-CRN investigators at cancer centers and other academic institutions. CRN's research teams are comprised of scientists with expertise in epidemiology, health services, behavioral medicine, and biostatistics, as well as primary and specialty care clinicians. This environment has facilitated a comprehensive and integrated approach to studying ways to improve cancer screening, prevention, and care.

In addition to serving as the CRN's Principal Investigator, Dr. Wagner has been instrumental in developing the CRN's cancer chemotherapy data resource. This resource has enabled a current NCI Grand Opportunity grant (CA148185) on comparative effectiveness research of treatment for late-stage cancer (Principal Investigators: Dr. Debra Ritzwoller and Dr. Jane Weeks).

Dr. Wagner also has led other ARP-funded studies examining the quality of cancer care. For example, he has conducted a series of case studies and qualitative research in selected locations across the nation on the quality of cancer care. This project, which found problematic gaps in care coordination and communication during the crucial period between the initial suspicion of cancer and initiation of treatment, became the foundation for a current cluster randomized trial on a nurse navigator intervention to improve coordination of care in the early phase of cancer diagnosis and treatment.

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Significance of the research & results

Patients and health care systems worldwide have benefited from Dr. Wagner's commitment to transforming health care in cancer as well as other diseases. His work with CRN and other research activities has led to significant enhancements in our ability to incorporate advances in quality improvement research into clinical practice and to catalyze positive health systems change. His research accomplishments are being honored this year by his receipt of the William B. Graham Prize for Health Services Research.

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Recent related publications of interest

Battersby M, Von Korff M, Schaefer J, Davis C, Ludman E, Greene SM, Parkerton M, Wagner EH. Twelve evidence-based principles for implementing self-management support in primary care. Jt Comm J Qual Patient Saf 2010 Dec;36(12):561-70. Review. [View Abstract]

Bowen JL, Provost L, Stevens DP, Johnson JK, Woods DM, Sixta CS, Wagner EH. Assessing Chronic Illness Care Education (ACIC-E): a tool for tracking educational re-design for improving chronic care education. J Gen Intern Med 2010 Sep;25 Suppl 4:S593-609. [View Abstract]

Bowen JL, Stevens DP, Sixta CS, Provost L, Johnson JK, Woods DM, Wagner EH. Developing measures of educational change for academic health care teams implementing the chronic care model in teaching practices. J Gen Intern Med 2010 Sep;25 Suppl 4:S586-92. [View Abstract]

Bowen JL, Wagner EH, Stevens DP. Chronic care and education. J Gen Intern Med 2010 Sep;25 Suppl 4:S569. [Look up in PubMed]

Feigelson H, Bischoff K, Bowles E, Engel J, James T, Onitilo A, Single R, Williams A, Wagner E, McCahill L. PS2-24: Improving breast cancer surgery quality through a collaborative surgical database. Clinical Medicine and Research 2010;8(3-4):180. [Look up in PubMed Central]

Horner K, Wagner E, Bowles EA, Kirlin B, Tuzzio L. Ps3-29: The benefits of stakeholder involvement in research. Clinical Medicine and Research 2010;8(3-4):201. [Look up in PubMed Central]

Johnson JK, Woods DM, Stevens DP, Bowen JL, Provost LP, Sixta CS, Wagner EH. Joy and challenges in improving chronic illness care: capturing daily experiences of academic primary care teams. J Gen Intern Med 2010 Sep;25 Suppl 4:S581-5. [View Abstract]

McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 2011 Jan-Feb;61(1):50-62. Review. [View Abstract]

Stevens DP, Bowen JL, Johnson JK, Woods DM, Provost LP, Holman HR, Sixta CS, Wagner EH. A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices. J Gen Intern Med 2010 Sep;25 Suppl 4:S574-80. [View Abstract]

Wagner EH, Aiello Bowles EJ, Greene SM, Tuzzio L, Wiese CJ, Kirlin B, Clauser SB. The quality of cancer patient experience: perspectives of patients, family members, providers and experts. Qual Saf Health Care 2010 Dec;19(6):484-9. [View Abstract]

Wagner EH. Academia, chronic care, and the future of primary care. J Gen Intern Med 2010 Sep;25 Suppl 4:S636-8. [View Abstract]

Clauser SB, Wagner EH, Aiello Bowles EJ, Tuzzio L, Greene SM. Improving modern cancer care through information technology. Am J Prev Med 2011;40(5S2):S198-S207.

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Last Modified: 03 Sep 2013