Opportunities for improvement (OFI) in guideline concordance (GLC) at National Comprehensive Cancer Network (NCCN) member institutions (MI).

Abstract

172 Background: The NCCN is implementing a performance improvement initiative using breast cancer (BC) practice data from NCCN MIs to improve institutional delivery of GLC and identify tailored opportunities for improving efficiency and quality of care delivered. Methods: This initiative includes evaluation of baseline GLC, review of non-concordant (NC) cases, design of tailored institutional interventions, and post-intervention evaluation of GLC and reasons for NC. BC patients presenting from July 2007 to March 2009 at 11 NCCN MIs were included in the baseline review. Six Category 1 GLC and 3 ASCO/NCCN quality measures evaluating adjuvant chemotherapy (CTX), endocrine therapy (ET), and radiation (XRT) were reviewed. GLC was assessed using the NCCN Outcomes database. Results: Aggregate GLC across all measures was 90% (MI range 66% to 100%). Review of NC cases was used to develop tailored OFI interventions. Three MIs are focusing on clinical practice improvement via provider education and feedback and integration of electronic medical record flags for treatment consideration. Nine MIs are working on improving access and reducing time-to-treatment lags. Currently, half of MIs are implementing and half are evaluating OFI interventions. Conclusions: This program supports data-driven QI efforts at MIs with the goal of improving efficiency and quality of care delivered to patients at participating sites, as well as serving as a model for data-driven quality improvement programs. [Table: see text]