Impact of a quality improvement initiative in ovarian cancer in 2 large U.S. hospital systems

Abstract

<h3>Objectives:</h3> To identify areas for improvement and design system-based strategies to address challenges in the provision of quality ovarian cancer care, we undertook a quality improvement (QI) program at 2 large US-based hospital systems. <h3>Methods:</h3> At baseline, between 9/2019 and 2/2020, we audited 200 EMR records (100 from each system) of adult patients with recurrent ovarian cancer for assessing physicians' performance of quality-based and National Comprehensive Cancer Network (NCCN) guideline-directed biomarker testing, maintenance treatment, monitoring, and patient-centered practices. Multidisciplinary ovarian cancer teams in each center participated in QI interventions including feedback on baseline EMR results and development of action plans. Post-intervention, 200 additional recurrent ovarian cancer patient EMRs were retrospectively reviewed in each center between 2/2020 and 9/2020 to determine the effect of the intervention on ovarian cancer care. <h3>Results:</h3> At baseline, for 200 patients diagnosed with ovarian cancer who's EMR were audited, the mean age was 66 years and the average time since diagnosis was 3 years. In these patients, documentation of <i>BRCA1/2</i> testing, use of maintenance therapy, patient follow-up, and shared decision-making (SDM) were sub-optimal (<i>Table</i>). Action plans, such as development of resources for guidance with regard to therapy sequencing and patient management strategies, development of a new adverse event management plan, and improvements in documentation and care coordination procedures, were implemented. In the post-intervention EMR audits, 200 patient's demographics were similar to baseline: the mean age was 62 years and the average time since diagnosis was 3 years. At follow-up, EMR audits demonstrated a significant 46% improvement in <i>BRCA1/2</i> testing (<i>P</i><0.001). Maintenance therapy use for patients who responded to platinum-based chemotherapy was numerically, though not significantly, improved from 39% to 47% (<i>P</i>=0.170); the use of PARP inhibitors for maintenance therapy was significantly improved from 4% to 13% (<i>P</i>=0.005). Numerical, though not significant improvements, were also seen in documentation of adverse event monitoring. Documentation of patient monitoring for recurrence were significantly improved over baseline: recurrence monitoring improved from 33% at baseline, to 95% at follow-up (<i>P</i><0.001). Finally, significant improvements in documentation of aspects of SDM were seen at follow-up including improvements in patients who were asked or counselled about treatment goals (44% improvement), treatment expectations (22% improvement), and concerns and fears (29% improvement). <h3>Conclusions:</h3> These results demonstrate that aligning care with guidelines can be challenging; however, implementation of system- and team-based interventions can lead to improved documentation of care practices. These methods and findings from this program are relevant for the future design of intervention to improve the quality of recurrent ovarian cancer care.