eP234 - Achieving National Accreditation Program for Rectal Cancer Standards at a Safety Net Hospital; Is It Feasible?

Purpose/Background: The National Accreditation Program for Rectal Cancer (NAPRC) was established as a standardized quality program to enhance the quality of care for rectal cancer patients. NAPRC promotes adherence to the highest quality in all aspects of rectal cancer management in surgery, radiology, pathology, oncology and multidisciplinary care. Our study aims to evaluate the feasibility of compliance with NAPRC standards at a safety-net hospital and identify areas of poor compliance.Methods/Interventions: A retrospective chart review was performed for adult patients diagnosed with rectal cancer in 2022 at a safety-net hospital in Los Angeles County. Patients who did not receive care at our institution or lost to follow-up were excluded. The primary outcome was the compliance rate with the 2020 NAPRC patient care standards. NAPRC standards reviewed were pretreatment pathology assessment, standardized radiology staging and laboratory test, appropriate timeline of treatments, synoptic documentation of operative and pathology reports and compliance with rectal cancer multidisciplinary tumor board. Secondary outcomes were underlying causes of non-compliance to these standards.Results/Outcomes: 20 patients were diagnosed with rectal cancer during 2022 at our safety net hospital of which 14 fit our inclusion criteria. Our safety net hospital was 100% compliant with 3 of the 13 NAPRC standards including pathology assessments, staging CT and CEA tests. The median time to definitive treatment was 56 days with 7 (50%) patients starting treatment >60 days after diagnosis. 6 (43%) patients underwent total neoadjuvant treatment and surgery, 7 (50%) patients underwent palliative chemotherapy and 1 (7%) patient deferred intervention for hospice care. 1 patient diagnosed at an outside hospital required repeat biopsy for tissue diagnosis delaying start of definitive treatment. 12 (86%) patients were locally staged with MRI and 2 patients deferred MRI. No MRI report contained all elements required per NAPRC standards with areas of least compliance being tumor location to anatomic structures (6/12, 50%) and tumor morphology (2/12, 16%). Most operative reports missed required NAPRC standards with the most common missing elements being ASA class (0/6), mobilization of splenic flexure (1/6) and distal margin (2/6). Most (5/6, 83%) surgical pathology reports included all NAPRC elements, and all surgical pathology was completed within 2 weeks. 5 (36%) patients were discussed at a CoC accredited multidisciplinary tumor board with documented treatment recommendations prior to initiation of definitive treatment. No patients received adjuvant chemotherapy.Conclusion/

Discussion: NAPRC standards outline 13 patient care expectations which were studied. At our safety net hospital only 23% on NAPRC standards were met in 2022. The most significant deviations from NAPRC standards were in MRI and operative reporting. In order to improve adherence to NAPRC standards future work should be directed in educating surgeons and radiologist of key components of operative and MRI reporting for rectal cancer. Furthermore, additional multidisciplinary efforts are being invested to increase compliance with perioperative rectal cancer tumor board requirements. National Accreditation Program for Rectal Cancer (NAPRC) Patient Care Expectations​