Quality Oncology Practice Initiative Measures Research Articles

Quality of telehealth-provided cancer care in VA.

1633 Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.

Enhancing Cancer Care Through Quality Initiatives: The Uganda Cancer Institute Experience With the Quality Oncology Practice Initiative.

Cancer care in low- and middle-income countries (LMICs) faces numerous challenges, such as limited resources, infrastructure constraints, and a shortage of specialized training. To address these challenges, innovative quality improvement (QI) approaches are required. The Quality Oncology Practice Initiative (QOPI) by the ASCO provides a framework for improving care quality through evidence-based standards. This article explores how QOPI has been adapted to the local context of the Uganda Cancer Institute (UCI) and highlights the importance of aligning international best practices with local health care realities to bridge disparities in care standards. The adaptation of the QOPI program at UCI commenced with a collaborative meeting with the ASCO-QOPI team in 2020. A tailored implementation plan was developed focusing on incorporating ASCO's QOPI measures and additional metrics relevant to the Ugandan context, engaging multidisciplinary teams, and optimizing resource use by leveraging existing resources for data collection and analysis. The execution of the plan relied heavily on staff training, participatory data collection, and continuous quality improvement processes that utilized data-driven methodologies. A retrospective analysis of QOPI data of UCI from 2020 to 2023 shows significant improvements in oncology care quality, highlighted by an upward trend in QOPI assessment scores across various metrics. These reflect the journey of UCI toward aligning its oncology care practices with international standards despite facing significant challenges. UCI's experience demonstrated the feasibility and impact of implementing international QI programs in LMICs. The success demonstrates that significant improvements in cancer care quality can be achieved in resource-constrained settings through adaptability, stakeholder engagement, and strategic resource optimization. UCI's journey is a model for other LMICs seeking to raise their cancer care standards, demonstrating that QI is necessary and attainable worldwide.

Standardization of data collection in the initial medical history: Implementation of an improvement plan in an oncology department.

306 Background: Non-standardized data collection in medical records has a negative impact on the quality of care: it increases the possibility of medical errors, hinders the performance of clinical studies, precludes the development of improvement plans and impedes accreditation in quality-of-care programs. The ASCO QOPI (Quality Oncology Practice Initiative) certification program accredits the quality of care of oncology departments through a self-assessment process. An overall quality score (OQS) above 75% on 26 measures that focus on quality of care and patient safety is required for application. In order to begin the certification process, we analysed the quality of the data collected in our initial medical history to implement improvement actions. Methods: Based on the 26 QOPI measures, plus 17 additional measures that were chosen by consensus as relevant, we performed a retrospective baseline analysis of the data collected in the initial medical history of patients assessed in June 2021. Patients with breast cancer, colorectal cancer and non-small cell lung carcinomas who initiated systemic treatment were included. Those who participated in clinical trials were excluded. The OQS of the 26 patients analyzed was 59%. Given this negative result, and once the problem was identified, the objective was established (OQS > 75%), changes were prioritized and an improvement plan was developed based on rounds of training, feedback and reinforcement to the entire medical team, and through the design of a template with the essential data to be collected. Results: With the baseline result of June 2021 (n = 26; OQS = 59%), improvement rounds were performed in November 2021 (n = 29; OQS = 82%), December 2021 (n = 26; OQS = 74%), January 2002 (n = 35; OQS = 75%), February 2022 (n = 32; OQS = 78%) and March 2022 (n = 31; OQS = 79%). Conclusions: Correct data collection in medical records is essential for quality of care. Simple short-term measures based on training, feedback and reinforcement, and the creation of a data template, have increased OQS from 59% to exceed the 75% threshold required by QOPI to apply for the certification program. However, a long-term sustainable plan needs to be established through the introduction of computerized checklists in the free-text electronic medical history.

Pre-Treatment Staging Imaging in Rectal Cancer: Results From the Quality Oncology Practice Initiative.

For patients with nonmetastatic rectal cancer, the National Comprehensive Cancer Network guidelines recommend initial staging using pelvic magnetic resonance imaging or endorectal ultrasound to determine the stage of the disease before initial therapy or surgery. This imaging workup helps determine the T and N staging, which is essential to determine optimal treatment for a patient. The current study examined practice concordance with this guideline using a quality measure in ASCO's Quality Oncology Practice Initiative (QOPI) that specifically addressed staging workup for patients with rectal cancer. From Fall 2016 through Fall 2019, 103 QOPI-participating practices reported performance on QOPI measure Colorectal 78, which addresses staging workup for patients with rectal cancer. The percentage and 95% CI of patients who received guideline-concordant imaging were calculated for each of the seven assessment time points. Difference of concordance rates between subsequent time points and the initial time point was assessed using logistic regression with random-effects models. In addition, 69 practices that submitted data in 2016 and 2017 were surveyed to gain insight on potential reasons for nonconcordance and the results were described. At each time point, a total of 20-33 practices reported data across 1,158 unique patients. Adherence appeared to increase over time, with 38% of patients receiving guideline-recommended staging in Fall 2016, to 56% in Fall 2019. The practice survey revealed that nonconcordance was mostly because of lack of care coordination between oncology and surgery disciplines (n = 16 practices of 28, 57.1%) and a lack of awareness of appropriate staging scans (n = 8 practices, 28.6%). As one half to one third of patients still do not receive appropriate imaging, our findings highlight the need for concerted quality improvement efforts that involve the multidisciplinary team to close this gap.

Quality Care in Survivorship: Lessons Learned From the ASCO Quality Oncology Practice Initiative.

The ASCO Quality Oncology Practice Initiative (QOPI) project was established to evaluate the influence of guideline recommendations on routine clinical practice. QOPI provided summary data from 839 unique practices in which data were collected every six months from the Fall of 2015 to the Spring of 2019. From these data, six items were chosen based on their relationship to domains of survivorship. A zero-inflated negative binomial regression model was used to test for trends in QOPI measures adherence rates over time. The models were adjusted for the time period, region, practice-ownership, multispecialty site, fellowship program, and hospital type. Smoking cessation counseling recommended and smoking cessation counseling administered or referred both increased over time, 50%-61% (adjusted incidence rate ratios (IRR), 1.028; 95% CI, 1.016 to 1.040; P < .001) and 34%-49% (adjusted IRR, 1.052; 95% CI, 1.035 to 1.070; P < .001), respectively. Infertility risks discussed before chemotherapy increased from 36% to 53% (adjusted IRR, 1.056; 95% CI, 1.035 to 1.078; P < .001) and fertility options discussed or referred to specialists increased from 23% to 38% (adjusted IRR, 1.074; 95% CI, 1.046 to 1.102; P < .001). Twenty-nine percent documented a positron emission tomography, computed tomography, or bone scan within the first 12 months for women diagnosed with early breast cancer treated for curative intent (adjusted IRR, 1.000; 95% CI, 0.977 to 1.024; P = .971). Tumor marker surveillance within 12 months increased from 78% to 87% (adjusted IRR, 1.018; 95% CI, 1.002 to 1.033; P = .023). As scientific evidence to guide cancer survivorship care grows, the role of guideline recommendations permeating clinical practice using quality metrics will become increasingly important.

Successful Implementation of a Quality Improvement Intervention Toward a QOPI-Certified Breast Cancer Center in Mexico.

As part of a quality improvement (QI) project undertaken during the 2018 edition of the American Society of Clinical Oncology's Quality Training Program (QTP), we evaluated our practice's compliance to 70 measures regarding the Core, Symptom/Toxicity and Breast Cancer modules from the Quality Oncology Practice Initiative (QOPI) database. Thirteen measures were identified as being consistently low in documentation rate in our medical records (MR). After establishing a multidisciplinary QI team, we defined to accomplish 100% documentation rate of these 13 QOPI measures in ≥ 80% of the monthly new patient MRs during the 6-month QTP. We designed a Microsoft Word MR template and implemented a new pre-consultation process. Monthly Plan-Do-Study-Act cycles were conducted to assess the performance of the intervention. After the 6-month QI intervention, > 80% of our monthly MRs achieved 100% compliance to the aimed-for 13 QOPI measures. Furthermore, our new pre-consultation process proved to be valuable in facilitating the documentation of data without interfering with the oncology appointment. The development of a systematic QI approach effectively enhanced our compliance to 13 QOPI measures over a 6-month period. These results led to the standardization of the current model of care at our institution. To our knowledge, Hospital Zambrano Hellion's Breast Cancer Center is the first Mexican cancer center to pursue a QOPI certified practice.

Evaluation of pharmacist interventions in a head and neck medical oncology clinic.

Head and neck cancers (HNC) are a complex and heterogeneous group of cancers, often necessitating a multidisciplinary approach across the care continuum. Oncology pharmacists are uniquely qualified to play a vital role on a multidisciplinary team and provide specialized care to optimize medication therapy. This was a retrospective chart review evaluating the role of a board-certified oncology pharmacist in the head and neck oncology clinic at an academic, comprehensive cancer center from April 2017 through March 2018. The primary objective of the study was to describe the types of interventions made by the oncology pharmacists. Secondary objectives included quantifying time spent on patient education and number of prescriptions sent to pharmacies. The pharmacist had 873 encounters with 151 patients, resulting in 2080 interventions. Approximately 57% of the interventions were performed in the clinic. Patient education (58%), facilitation of new prescriptions or refill requests (49.9%), and supportive care management (32.6%) were the most frequent interventions. The oncology pharmacist spent 154.1 h on patient education and sent 811 prescriptions to pharmacies, with 63.6% of prescriptions sent to the institution's cancer center pharmacy. The incorporation of an oncology pharmacist in the HNC team optimized patient care through comprehensive and timely interventions across the care continuum. Our study is the first to highlight the vital role oncology pharmacists have in improving the overall quality of care of HNC patients. Future directions include exploring the impact of oncology pharmacist interventions on select Quality Oncology Practice Initiative measures by the American Society of Clinical Oncology.

Multi-institution quality improvement in supportive oncology: Results of the Coleman Supportive Oncology Collaborative (CSOC).

33 Background: The Institute of Medicine and Commission on Cancer recommend systematic delivery of supportive oncology care for cancer patients. The CSOC is focused on quality improvement (QI) of supportive care across Chicago cancer centers (Weldon ASCO ’17). Supportive oncology includes distress, practical, family, physical, nutrition, pain, fatigue and care concerns. To support QI, cross-institution teams developed unique, relevant tools, methods, care delivery processes, patient handouts and online training. Methods: Ten centers (5 academic, 1 VA, 1 public, 2 safety net, 1 community) implemented supportive oncology screening and care delivery quality improvements. Centers collected data for relevant Quality Oncology Practice Initiative (QOPI) metrics. Analyses used simple frequencies and Fishers exact test. Results: Five of six QOPI measures were improved at statistically significant levels from 2014 to 2017, p &lt; .00001. Improvements are more modest in 2016 &amp; 2017 as 4 of the centers started this QI in 2017. Conclusions: The CSOC achieved significant improvements in supportive oncology screening and identifying and addressing patients’ needs and concerns. Additional work is needed to improve these measures to achieve the best quality of cancer care possible for every patient based on their needs and concerns. [Table: see text]

Retrospective evaluation of clinical evidence submitted with off-label requests at a community-based oncology infusion center.

254 Background: A systematic grading system was created to evaluate literature submitted with off-label requests to the Inova Schar Cancer Institute (ISCI) oncology P&amp;T. Level of evidence (LOE) 1A, 1B, and 1C are granted immediate approval. LOE 2A, 2B, 2C require two members (MD and PharmD) to approve. LOE 3A, 3B, 3C require 3/4 (2MDs, 2PharmDs) members to approve. LOE no benefit (NB) is denied approval. Methods: Identified off-label requests for hematology/oncology patients from December 23, 2016 to January 2, 2019. Primary objective was retrospective evaluation of literature submitted using a systematic grading system through the oncology P&amp;T. Secondary objective was to evaluate financial and clinical outcomes of off-label treatments, including compliance with Quality Oncology Practice Initiative measures. Future aim is to compare LOE and treatment outcomes pre- and post-implementation. Results: There were 73 off-label requests with 126 references submitted as supporting literature. The most frequently requested treatments were nivolumab (21.9%) and pembrolizumab (20.5%). The most common disease state was breast cancer. The LOE for the literature submitted was 1A (10.3%), 1B (23%), 1C (8.7%), 2A (9.5%), 2B (7.9%), 2C (4.8%), 3A (1.6%), 3B (7.1%), 3C (5.6%), and NB (21.4%). Sixty-six treatments were approved and 54 patients received at least one dose of off-label treatment. Thirty off-label requests were made based on molecular tumor board recommendations. Off-label treatment was discontinued for disease progression (29.6%), toxicity (25.9%), or death (14.8%). Three patients completed therapy and 11 received subsequent treatment after discontinuation of the off-label treatment. Average time from last treatment to death was 41.8 days (median 21, range 6-175). Eleven of 55 expired patients received hospice care prior to expiring. Most off-label treatments were approved by third party insurance (55.6%) while 37% were covered by manufacturer provided free drug and 7.4% were paid for by the ISCI Foundation. Conclusions: The standardized grading system for off-label treatments can be implemented to ensure safe and effective use of off-label treatments in oncology patients.

NCI and ASCO CancerLinQ collaboration to advance quality of cancer care and surveillance.

e18317 Background: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program curates population-based cancer data representing 34% of the US population. CancerLinQ is an ASCO initiative that collects and analyzes electronic health record (EHR) data to give oncologists opportunities to improve the quality of patient care. With the shared goal of understanding care delivery, NCI SEER and CancerLinQ launched a pilot linkage. Purpose: Establish data exchange between registries and oncology practices to a) provide clinicians with SEER data to more effectively evaluate care within their practices, and b) enhance ability of SEER registries to capture cancer-related data and facilitate compliance of legally mandated public health reporting requirements while supporting metrics for quality reporting to providers. Methods: The SEER Iowa Cancer Registry is developing bidirectional linkages with CancerLinQ practices. The initial pilot in Iowa establishes connectivity and a data pipeline to capture discrete data elements in EHRs. The linkage methods are securely conducted by IMS, an honest broker for the Registry and ASCO. Patterns of care will be evaluated in the matched patient population. Analysis of shared data elements will provide comparative validation of data captured electronically (EHR) and manually (abstraction). Enhancing the patient care quality through efficient utilization of shared data was paramount when selecting treatment-related Quality Oncology Practice Initiative (QOPI) measures for calculation focusing on breast (QPP 449, QPP 450) and prostate cancer (QPP 102, QPP 104). Results: Publicly available SEER data for cohort evaluation is available to providers via SEERLinQ. The two-way exchange data pipeline complies with reporting requirements. Validation of shared data elements, statistics for matched patients, improved data completeness measures, and automated calculation of QOPI measures will be demonstrated. Conclusions: This collaboration builds an initial foundation of curated Registry-EHR linked data to automate cancer reporting to lower the physician burden, improve SEER evaluation of clinical care patterns, and enhance patient care quality.

Multi-institution quality improvement in supportive oncology: Results of the Coleman Supportive Oncology Collaborative (CSOC).

6606 Background: The Institute of Medicine and Commission on Cancer recommend systematic delivery of supportive oncology care for cancer patients. The CSOC is focused on quality improvement (QI) of supportive care across Chicago cancer centers (Weldon ASCO ’17). Supportive oncology includes distress, practical, family, physical, nutrition, pain, fatigue and care concerns. To support QI, cross-institution teams developed unique, relevant tools, methods, care delivery processes, patient handouts and online training. Methods: Ten centers (5 academic, 1 VA, 1 public, 2 safety net, 1 community) implemented supportive oncology screening and care delivery quality improvements. Centers collected data for relevant Quality Oncology Practice Initiative (QOPI) metrics. Analyses used simple frequencies and Fishers exact test. Results: Five of six QOPI measures were improved at statistically significant levels from 2014 to 2017, p &lt; .00001. Improvements are more modest in 2016 &amp; 2017 as 4 of the centers started this QI in 2017. Conclusions: The CSOC achieved significant improvements in supportive oncology screening and identifying and addressing patients’ needs and concerns. Additional work is needed to improve these measures to achieve the best quality of cancer care possible for every patient based on their needs and concerns. [Table: see text]

The Quality Oncology Practice Initiative Program: Experience in Spain.

e18267 Background: Patient care quality is a discipline with enormous relevance in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in quality for oncology practices. The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: 7 rounds of data collection have taken place (Fall 2015 to Round 2 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered them the necessary support. 18 Spanish hospitals have participated in the 7 rounds, and 12 of them have repeated participation. Core, Lung Cancer and Breast Cancer modules were completed. Results: During the 7 rounds, 2341 charts were submitted by the Spanish practices. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, 100% in the three following rounds and 88% in the last round. For the 12 hospitals that repeated participation, 8 reported improvements at different degrees of their global scores. These hospitals specifically show an improvement in the QOPI measures related to the signed patient consent for chemotherapy and the documentation of the patient consent in the practitioner note, the chemotherapy intent documentation, the appropriate completion of the chemotherapy planning, the documentation of the number of chemotherapy cycles and the development and documentation of the pain assessment. On the other hand, regarding QOPI Certification, three Spanish hospitals have received this accreditation in September 2017 and one in June 2018. Conclusions: These preliminary results are a good starting point for the continued implementation of the QOPI program in Spain, thus providing a well-structured approach to analyze cancer care. The ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, with these performed for the first time in Spain in 2017 and 2018 respectively.

Evaluating the Impact of Treatment Care Planning on Quality Measures.

The Center for Medicare & Medicaid Innovation Oncology Care Model (OCM) requires documentation of a 13-point Institute of Medicine care management plan for Medicare patients. In addition, OCM includes evaluation of quality using key performance measures that align with the ASCO Quality Oncology Practice Initiative (QOPI). Both efforts are designed to improve patient-centered care and foster patients' engagement in their care plan. A multicenter quality improvement project was conducted to develop a strategy to meet the OCM treatment planning (TP) requirement (Plan), pilot clinician education coupled with use of electronic TP in early-stage breast cancer (Do), evaluate the impact of TP on QOPI measures (Study), and develop recommendations for future implementation (Act). Thirty-three clinical providers and 171 women with breast cancer were included. Improved performance on several QOPI measures was observed for the intervention group compared with the historical control group. Meeting the OCM TP requirement through incorporating a technology solution provided an opportunity for quality improvement and preparation for full-scale TP within the OCM. TP delivery was associated with improved performance on select ASCO QOPI measures, which is likely to correspond with improved performance on quality measures within OCM.

Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction

Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.

The impact of value-based payment on the referral of oncology patients to tobacco cessation services.

116 Background: The purpose of this study is to investigate the relationship between the introduction of value-based payment, the initiation of a quality improvement project, and practices’ performance to refer or administer tobacco cessation counseling to patients. Methods: The Michigan Oncology Quality Consortium (MOQC) is a statewide quality collaborative sponsored by Blue Cross/Blue Shield of Michigan (BCBSM). MOQC uses ASCO's Quality Oncology Practice Initiative (QOPI) for measurement.Value-based payment (VBP) was introduced in 2017 by BCBSM. The VBP is achieved if a region reaches a target established for four QOPI measures. One of the four quality measures is QOPI's core measure 22bb: tobacco cessation counseling administered or patient referred. At the time the VBP was introduced, a subset of MOQC practices chose to initiate a quality project to improve performance on this measure. Analyses describes the performance of all MOQC practices with the introduction of the VBP, and performance of the practices who chose to revise their tobacco cessation processes to address performance. Results: The proportion of patients who were administered or referred to tobacco cessation services in participating MOQC practices was 49% (n = 793 charts) from abstracted rounds Spring 2014 - 2017. After the introduction of VBP, this proportion increased to 58% (n = 307 charts) in Fall 2017. Performance improved on this QOPI measure for both subsets of MOQC practices - those practices that chose to initiate a quality project focused on this measure (n = 19) and practices that selected another measure (n = 27). Practices that developed a quality project improved their aggregate proportion from 46% (Spring 2014-2017, n = 839 charts) to 51% (Fall 2017, n = 266 charts). Practices that focused on another quality measure improved from 51% (Spring 2014-2017, n = 789 charts) to 65% (Fall 2017, n = 265 charts). Conclusions: Our data suggest that the presence of VBP may have had a positive impact on referral patterns for tobacco cessation services for cancer patients. Additional analyses are required to determine if there is a combination or sequencing of VBP and process improvement strategies to optimize the delivery of quality care.

Implementation of a regional structure across an oncology collaborative quality initiative and the impact on physician engagement.

149 Background: The Michigan Oncology Quality Consortium (MOQC) is a statewide collaborative quality initiative (CQI) sponsored by Blue Cross/Blue Shield of Michigan. The consortium uses Quality Oncology Practice Initiative (QOPI) measures to identify gaps in care and opportunities to improve quality. Data are collected on patients regardless of payer. MOQC includes nearly 90% of eligible medical oncologists (n = 364) in Michigan. We describe physician engagement within MOQC and quality improvement efforts after implementation of a regional structure in the CQI. Methods: The MOQC regional structure was introduced in Spring 2017. Forty-eight practices self-selected into 6 regions roughly by geographic location. Beginning in Spring 2017, a physician from each practice was required to attend both the Spring and Fall Regional Meetings and encouraged to bring an additional representative (e.g. administrative leader) from their practice. Regional meetings were facilitated by the MOQC Coordinating Center. Within each region, practices selected to work on one measure from a finite set of QOPI measures. and shared best practices gleaned from their quality improvement work, according to the Plan-Do-Study-Act cycle of quality improvement. We report on our primary outcome, the change in physician engagement, defined as attendance at biannual MOQC meetings (distinct from the Regional Meetings), before and after the introduction of the regional structure. Results: Provider engagement, measured by attendance at the biannual meetings increased from an average of 17.3 physicians in the 3 years before the introduction of the regional structure, to 33 physicians in the first meeting, and 22 physicians in the second meeting after the introduction of the regional structure. Conclusions: Implementation of a regional structure increased provider engagement, and provided a systematic approach to the launching of quality improvement efforts in an oncology CQI. Engaging providers at the regional level, which incorporates cultural aspects of geographically similar practices, may provide opportunities not otherwise recognized in larger consortia.

Oral chemotherapy education sessions at an academic and community cancer center.

254 Background: Oral chemotherapy is becoming more widely utilized within oncology. Concerns regarding poor adherence and toxicity may be addressed by providing patient education. Methods: We developed and implemented a pharmacist-led initial education session for patients newly prescribed oral chemotherapy in both an academic medical center gastrointestinal oncology clinic and an affiliated community oncology cancer center. We provided an education packet including drug-specific information, clinic contact telephone numbers, and a drug schedule calendar. Standardized teaching and documentation templates were used. Patients completed each education session with the MOATT teaching tool for patients receiving Oral Agents for Cancer V1.2. Assessment of compliance with the ASCO/ONS Chemotherapy Administration Safety Standards on Oral Chemotherapy Education was assessed through use of Quality Oncology Practice Initiative (QOPI) quality measures where applicable and compared to historical QOPI data from the academic medical center from 2015-2017. Results: Thirty-one patients were newly prescribed oral chemotherapy and received the initial education session from November 2017 through May 2018. Based on a monthly report generated of new oral chemotherapy prescriptions, after a seven-month run-in, the rate reached 100% of patients at both sites for the most recent month. When comparing the intervention cohort to the historical QOPI cohort using a one-sided P value of 0.017 with bonferroni correction, there was improvement in safe handling/storage (pre: 19%, post 100%, P = 0.0001), drug-drug and food interactions (pre: 31%, post 100%, P = 0.0001), and plan for missed doses (pre: 37%, post: 97%, P = 0.0001). A trend toward improvement was found for schedule/start date discussion (pre: 87%, post: 100% P = 0.018) and side effect/toxicities (pre: 87%, post: 100% P = 0.018). Conclusions: Implementation of an oral chemotherapy education session in both an academic and community setting was feasible and improved adherence to QOPI measures of oral chemotherapy education and ASCO/ONS standards for oral chemotherapy. Further data regarding time to clinical outcomes is forthcoming.

Oncology Pharmacist Opportunities: Closing the Gap in Quality Care.

ASCO has worked to facilitate the improvement in quality oncology care via the development of the Quality Oncology Practice Initiative (QOPI). The extent to which the ASCO QOPI identifies areas in which pharmacists may enhance care is not known. These findings are important, as pharmacists are an integral part of the care team, providing direct clinical care in addition to medication use guidelines and practice-based policies. In addition, high-performing practices may receive reimbursement from the Centers for Medicare and Medicaid Services. Three pharmacists reviewed 200 QOPI measures for potential pharmacist involvement. We used the Hematology/Oncology Pharmacy Association Scope of Practice document and a validated summary of services provided by board-certified oncology pharmacists to identify which practice domains and pharmacy services would best fit the care provided by the selected QOPI measures. A total of 177 QOPI measures were analyzed. Potential areas of pharmacist impact were identified in 67 (38%) of the included metrics. Measures largely related to optimizing drug therapy through the development and implementation of pharmacy guidelines. Patient counseling and symptom management are services that best described the majority of QOPI measures deemed actionable by a pharmacist. We also found that several QOPI measures pharmacists can intervene upon overlap with metrics currently assessed for reimbursement via the Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System. Oncology pharmacists are uniquely positioned to improve the quality of care provided to patients with cancer within the team-based setting.

Automating Quality Oncology Practice Initiative Quality Measure NHL78a.

Quality measurement and improvement is a focus of ASCO. In the era of electronic health records (EHRs), computerized order entry, and medication administration records, quality monitoring can be an automated process. The EHR data are usually stored within tables in a relational database management system. ASCO Quality Oncology Practice Initiative measure NHL78a (hepatitis B virus antigen test and hepatitis B core antibody test within 3 months before initiation of obinutuzumab, ofatumumab, or rituximab for patients with non-Hodgkin lymphoma) presents an opportunity for automation of a quality measure using existing data in the EHR. We used a locally developed Structured Query Language (SQL) language procedure in the Microsoft SQL Query Manager to access the EPIC CLARITY database. Access to the relational database management system of the EHR permits rapid case identification (the denominator set) of the unique ID of all of the patients who have received one of the target medications (ie, obinutuzumab, ofatumumab, or rituximab). Then, we went through a six-step process to find the number of patients who passed or failed the quality measure. When the final SQL procedure executes, it takes < 5 seconds to see the result set for a 12-month period. The procedure can be changed to incorporate a desired date range. Once the SQL procedure is created, there is essentially no labor and low costs to run the procedure at specific time intervals. Our method of quality measurement using EHRs is cost effective, fast, and precise, and can be reproduced at other centers.

Longitudinal assessment of performance using the QOPI measure in Brazilian oncology care.

e18184 Background: The Quality Oncology Practice Initiative (QOPI) provides a standardized approach to assessing performance on a series of evidence- and consensus-based process measures in oncology. In 2015, the QOPI was utilized in a large oncology practice in Brazil to provide a baseline assessment, identify practice deficiencies and guide improvements. Feedback was provided to the oncology team and specific actions identified. This study reports the results of the follow-up QOPI assessment 2 years after the initial baseline was recorded. Methods: From data obtained in 2015 instructions were established for the documentation of physical and psychological symptoms, and of diagnosis and treatment discussions with patient, side effects and infertility risk, informed consent, and genetic services. No significant differences were found in the sociodemographic and clinical characteristics of the patient cohorts. Results: There was an overall increase in performance (60.6% to 77.1%; p &lt; .01). Elements of medical care and of cancer management still consistently and appropriately documented (e.g., pathology, stage, and treatment). There were a significant improvement in performance on measures related to pain assessment (59.5% to 84.5%), and symptom/toxicity management (62.3% to 91.2%). Relatively poor performance persisted however, most notably in the assessment of patients’ psychosocial status (26.5%), discussion of treatment goals (45.6%) and fertility risks (7.4%). Informal feedback was garnered from team concerning areas of ongoing deficiency. Conclusions: There was a significant improvement in adherence to QOPI indicators. Performance in a number of domains remained relatively poor, despite clinical efforts. The reasons are likely multifactorial; and may include a lack of specific resources in a public service (e.g., absence of a fertility service), clinician-based factors that can be culturally driven (e.g., discomfort discussing prognosis), and inconsistent chart documentation. The QOPI provides important guidance in improving oncology care, with the current study suggesting a need for training on psychosocial assessment, as well as the role of an EMR system in ensuring appropriate documentation.