Importance Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost.

Objective To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing “high value” that may be tested and adopted by others to produce similar results.

Design, Setting, and Participants “Positive deviance” was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results. To quantify value, oncology practices located near the US Pacific Northwest and Midwest with low mean insurer-allowed spending were identified. Among those, practices with high quality were selected. A team then conducted site visits to interview practice personnel from June 2, 2015, through October 3, 2015, and to probe for attributes of high-value care. A qualitative analysis of their interview results was performed, and a panel of experienced oncologists was convened to review attributes occurring uniquely or frequently in low-spending practices for their contribution to value improvement and ease of implementation. Four positive deviant (ie, low-spending) oncology practices and 3 oncology practices that ranked near the middle of the spending distribution were studied.

Main Outcomes and Measures Thematic saturation in a qualitative analysis of high-value care attributes.

Results From the 7 oncology practices studied, 13 attributes within the following 5 themes emerged: treatment planning and goal setting, services supporting the patient journey, technical support and physical layout, care team organization and function, and external context. Five attributes (ie, conservative use of imaging, early discussion of treatment limitations and consequences, single point of contact, maximal use of registered nurses for interventions, and a multicomponent health care system) most sharply distinguished the high-value practice sites. The expert oncologist panel judged 3 attributes (ie, early and normalized palliative care, ambulatory rapid response, and early discussion of treatment limitations and consequences) to carry the highest immediate potential for lowering spending without compromising the quality of care.

Conclusions and Relevance Oncology practice attributes warranting further testing were identified that may lower total spending for high-quality oncology care.

重要性 癌症治疗费用昂贵。实践组织提供的癌症护理在治疗期间患者和付款人的总支出以及护理质量方面存在差异，这种不必要的变化导致了高成本。

目的 使用总支出和护理质量的变化来评估肿瘤学实践属性，区分“高价值”，其他人可以测试和采用以产生类似结果。

设计、设置和参与者 “正偏差”用于对访谈结果的探索性混合方法（定量和定性）分析。为了量化价值，我们确定了位于美国太平洋西北部和中西部附近、保险公司允许的平均支出较低的肿瘤学实践。其中，选择了高质量的实践。随后，2015 年 6 月 2 日至 2015 年 10 月 3 日，一个团队对实践人员进行了实地走访，探寻高价值护理的属性。对他们的访谈结果进行了定性分析，并召集了一个经验丰富的肿瘤学家小组来审查在低支出实践中独特或经常出现的属性，以了解它们对价值改进和易于实施的贡献。四正偏差（即，

主要成果和措施 高价值护理属性定性分析中的主题饱和度。

结果 从所研究的 7 种肿瘤学实践中，出现了以下 5 个主题中的 13 个属性：治疗计划和目标设定、支持患者旅程的服务、技术支持和物理布局、护理团队的组织和功能以及外部环境。五个属性（即，影像学的保守使用、治疗限制和后果的早期讨论、单点接触、注册护士的最大使用量以及多组成部分的医疗保健系统）最能明显地区分高价值的实践场所。肿瘤专家小组判断 3 个属性（即早期和规范化姑息治疗、非卧床快速反应以及对治疗限制和后果的早期讨论）在不影响护理质量的情况下具有最大的直接降低支出的潜力。

结论和相关性 确定了值得进一步测试的肿瘤学实践属性，这可能会降低高质量肿瘤护理的总支出。