Understanding the barriers to quality care in ovarian cancer: results from a needs assessment and quality improvement initiative

Abstract

Objectives: The Association of Community Cancer Centers (ACCC) launched an initiative to improve care for patients with ovarian cancer (OVCA) in the United States. The project was designed to identify areas of greatest need for quality improvement (QI) initiatives aimed at improving OVCA care. Methods: A needs assessment survey and workshop application was designed by a multidisciplinary committee and was administered online using Qualtrics. A full day onsite workshop was conducted with the care teams at each site which included a lecture by an OVCA expert, a guided discussion to identify problems and barriers to optimal care delivery, and development of a problem statement for the resulting project. A 6-month QI project utilizing Plan-Do-Study-Act Cycles was developed by each site with data benchmarks. Project specific data was collected and analyzed. Results: 26 programs submitted workshop applications. Program types varied, with the majority being Comprehensive Community Cancer Programs (n=6, 26.1%); Academic Comprehensive Cancer Programs (n=5, 21.7%); or NCI-Designated Comprehensive Cancer Programs (n=5, 21.7%). The median number of annual OVCA patients diagnosed per site was 50.5 (range 22-190). The median numbers of clinical trials per site were 0 Phase I, 1.5 Phase II, and 2 Phase III. Eighty-five percent of sites reported having OVCA multidisciplinary care teams. Genetic testing and counseling (GTC) was the most frequently requested topic for QI (see Table). Three sites were chosen for QI projects. Site 1 chose to improve GTC rates for patients with newly diagnosed OVCA by implementing an electronic medical record (EMR) notification. During the 6-month project, receipt of any genetic testing within 60 days of an initial encounter improved from 68% to 77% of patients. Site 2 also chose to improve the receipt and efficiency of GTC through the development and application of an EMR smartset. During the QI period, GTC improved from 4/27 (15%) retrospectively to 14/14 (100%) with time from diagnosis to GTC decreasing from 1-8 months to 0.5-2 months. The QI project at Site 3 was to improve enrollment onto clinical trials though insertion of an EMR phrase in the template relating to clinical trial eligibility. No change in clinical trials enrollment was identified during the QI period which spanned the initial phase of the COVID-19 pandemic. Download : Download high-res image (146KB) Download : Download full-size image Conclusions: Significant needs for the improvement of quality care delivery for patients with OVCA were identified across varied cancer care programs. Improved access to genetic testing and counseling was the most commonly identified need, followed by enhanced clinical trial enrollment. Using EMR tools, sites were able to rapidly increase rates of GTC. Increasing clinical trial enrollment using an EMR trigger was unsuccessful, largely due to effects of the COVID-19 pandemic. Ongoing work to improve the implementation of best practices in OVCA treatment is needed.