Improving quality at university based hematology/oncology fellowship continuity clinic with the quality oncology practice initiative (QOPI)

Abstract

6578 Background: Quality imporvement is an important component of improving cancer care and is now an ACGME requirement of fellowship training. The feasibility of integrating QI activities into fellowship training is not known. Methods: The Hematology/Oncology fellowship program at Duke University voluntarily participated in QOPI in Spring and Fall of 2007 in an effort to evaluate this quality improvement tool for compliance with ACGME requirements. For each round of chart abstractions, all patients seen in this clinic with lung cancer and colorectal cancer (charts identified by ICD-9 codes) within two years were screened for inclusion by the VA chief attending and 1–2 fellows; this screening process required approximately 6 hours.. EMR's of eligible patients were abstracted using the QOPI online tool by attending and fellow physicians. Each attending and fellow physician was assigned 6 to 8 patient charts to abstract data, and each chart required an average of 15 minutes. Results: During the Spring 2007 survey, there were multiple areas identified for improvement. A template was created within the electronic medical record based on this data to improve documentation. A specific hem/onc treatment note was implemented for all patients who are to receive chemotherapy or biotherapy (oral and IV) for their cancers. The template addressed areas for improvement including chemotherapy cycles, pain assessment and consent. Comparison of surveys revealed improvement in documentation of pain assessment (78% increase to 87%), chemotherapy intent discussion (72% increase to 86.5%) and number of chemotherapy cycles documented (54% increase to 90%). Conclusions: QOPI participation is viable option to comply with ACGME requirements. Participation may improve performance through increased awareness of quality measures. Implementation of required template into electronic medical record improves documentation. No significant financial relationships to disclose.