Quality Oncology Practice Initiative Program Research Articles

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.

Assessment of Spanish hospitals involved in the Quality Oncology Practice Initiative program.

305 Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the scores of the QOPI rounds from 14 Spanish hospitals, which submitted their charts from 2016 to 2021, and the measures obtained from 2018 to 2021, regarding the core/symptom, breast, colorectal (CRC) and NSCLC modules, in comparison with the QOPI aggregate measures. Results: Since 2016, 14 Spanish hospitals have participated in the QOPI program, achieving the certification 12 of them, and 3 are in process. Along the years, they have obtained a score over 85%, being 87,41% the worse in 2021, and 92,80% the best in 2020. We also analyzed the outstanding measures from 2018 onwards. The highest scores in Spanish hospitals were for information of infertility risks and chemotherapy intent prior to prescription, and documented plan for oral chemotherapy. However, measures regarding pain addressed, appropriate antiemetic therapy for high- and moderate-emetic-risk antineoplastic agents and action taken to address problems with emotional well-being by the second office visit, were among the lowest scored measures. When we focused in breast and NSCLC modules, Spanish hospitals didn´t show negative values, highlighting in the administration of Tamoxifen or AI within 1 year of diagnosis by patients with AJCC Stage IA (T1c) and IB - III ER or PR positive and in the status documentation for patients with initial AJCC Stage IV or distant metastatic NSCLC. In CRC module, Spanish hospitals showed lower scores in colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy. Conclusions: This study evaluates QOPI scores in Spain, showing that repeated participation enhances quality of care, although there is room for improvement. ECO Foundation will continue supporting Spanish practices to increase their participation aiming of improve oncology care in Spain.

Relationship Between Participation in ASCO's Quality Oncology Practice Initiative Program and American Board of Internal Medicine's Maintenance of Certification Program.

Medical oncologists have a variety of options for demonstrating proficiency in providing high-quality patient care. Perhaps, the best-known opportunity for demonstrating individual expertise and lifelong learning is the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) program. At the practice level, ASCO has offered the Quality Oncology Practice Initiative (QOPI) as a means of optimizing cancer care delivery. In this study, we assess the association between active involvement in MOC on an individual basis and whether that individual's practice is involved with the QOPI program. We evaluated 13,600 US medical oncologists initially certified by the ABIM and divided them into those initially certified before 1990 (the year in which ABIM started to require periodic recertification), those from 1990 to 2007, and those from 2008 to 2016. It was then determined which of these had let their certificates expire by 2020. These data were then compared with practices that participated in QOPI from 2017 to 2019, resulting in the matching of 97% of physicians. Of individuals initially certified before 1990 (and technically with lifelong certification), 22% were in QOPI practices. Among those who did not have lifelong certification, there was an association between QOPI participation and maintenance of ABIM certification. For those initially certified between 1990 and 2007, 35% of oncologists with up-to-date ABIM certification were in QOPI practices, whereas only 11% with expired ABIM certification were QOPI participants (P < .0001). For those in the 2008-2016 category, the numbers were 36% v 16%, respectively (P < .0001). Our analysis identifies a relationship between participation in these ABIM and ASCO proficiency programs. The reasons for this are likely complex and based on a variety of institutional, professional, monetary, and personal factors.

Implementation of the Quality Oncology Practice Initiative Program in Spain: First Results and Implications.

Measuring and tracking quality of care is highly relevant in today's health care. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. Excellence and Quality in Oncology Foundation, a collaboration of oncology experts from major Spanish hospitals involved in cancer treatment, reached an agreement with QOPI to include Spanish hospitals in this program. We analyzed the results of the QOPI Core module measures from 19 Spanish hospitals over nine rounds (from fall 2015 to fall 2019). Of the 19 hospitals, 15 completed more than one round; none participated in all nine (two hospitals participated in eight rounds). The highest scores were for pathology report confirming malignancy, documenting a plan of care for moderate or severe pain and chemotherapy dose, and chemotherapy administered to patients with metastatic solid tumor with performance status undocumented. Measures regarding a summary of chemotherapy treatment, tobacco use cessation counseling, and assessment of patient emotional well-being were among the lowest scored measures. Six of the 15 practices that participated repeatedly achieved a better score in their last round compared with their first. Overall, scores of Spanish hospitals improved from 67.79% in fall 2015 to 68.91% in fall 2019. To our knowledge, this is the first study to evaluate QOPI scores in Spain. There was high variability in scores, with quality of care improving with repeated participation in some hospitals, but worsening in others. Excellence and Quality in Oncology Foundation will support practices to increase their participation to improve oncology care and implement strategies that address the areas for improvement.

Evaluation of Spanish hospitals participating in the Quality Oncology Practice Initiative program.

222 Background: Measuring and tracking quality of care is highly relevant in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) program is a referral for evaluating oncology practices worldwide. The ECO Foundation (Excellence and Quality in Oncology), a collaboration of oncology experts from the major Spanish hospitals involved in cancer treatment, reached an agreement with ASCO (American Society of Clinical Oncology) to include Spanish hospitals in its QOPI program. Methods: We analyzed the results of the QOPI core module measures from 19 Spanish hospitals submitting their data in nine rounds (from Fall 2015 to Fall 2019). Results: Of the 19 hospitals, 15 participated more than once; none participated in all 9 rounds (2 hospitals participated in 8 rounds). The highest scores were for pathology report confirming malignancy, documenting plan of care for moderate/severe pain and chemotherapy dose, and chemotherapy administered to patients with metastatic solid tumor with performance status undocumented. Measures regarding a summary of chemotherapy treatment, tobacco use cessation counseling, and assessment of patient emotional well-being were among the lowest scored measures. Six of the 15 practices who participated repeatedly achieved a better score in their last round compared to their first. Overall, scores of Spanish hospitals improved from 67.79% in Fall 2015 to 68.91% in Fall 2019. Conclusions: This is the first study to evaluate QOPI scores in Spain; it showed that repeated participation enhances quality of care, although there is room for improvement. The ECO Foundation will continue supporting and engaging with practices to increase their participation in order to improve oncology care and implement strategies that address the areas for improvement.

Patient-centered oncology care: impact on utilization, patient experiences, and quality.

To determine whether implementation of patient-centered oncology standards in 5 medical oncology practices improved patient experiences and quality and reduced emergency department (ED) and hospital use. Retrospective, pre-post study design with a concurrent nonrandomized control group. We used insurance claims to calculate all-cause hospitalizations and ED visits and primary care and specialist office visits (n = 28,826 eligible patients during baseline and 30,843 during follow-up) and identify patients for a care experiences survey (n = 715 preintervention and 437 postintervention respondents). For utilization and patient experience outcomes, we compared pilot practices' performance with 18 comparison practices using difference-in-differences (DID) regression models accounting for practice-level clustering. We assessed pilot practice performance on 31 quality measures from the American Society of Clinical Oncology Quality Oncology Practice Initiative program. There were no statistically significant differences in hospital, ED, or primary care visits between the pilot and comparison groups over time, but there was a significant increase in specialty visits for the pilot group (adjusted DID of 0.07; 95% CI, 0.01-0.13; P = .03). For care experiences, pilot practices improved more on shared decision-making (4.03 DID composite score; P = .013), whereas the comparison group improved more on access (-6.36 DID composite score; P < .001) and exchanging information (-4.25 DID composite score; P = .013). On average, pilot practices improved performance on 65% of core quality measures from baseline to follow-up. This pilot of patient-centered oncology care showed improved quality but no impact on hospitalizations/ED use and mixed results for patient experiences. Findings are consistent with early evaluations of primary care patient-centered medical homes.

Implementation of the quality training program in Spain.

11 Background: The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Since 2015, ECO has been collaborating with ASCO (American Society of Clinical Oncology) in quality initiatives in cancer care, like the QOPI (Quality Oncology Practice Initiative) program and the QOPI Certification Program (QCP). The Quality Training Program (QTP) is a 6-month course with 3 in-person learning sessions that prepares oncology teams to design, implement and lead successful quality improvement activities in their practices. In 2018, ECO reached a new agreement with ASCO to implement this program in Spain. Methods: The QTP was developed in Spain by ECO in collaboration with ASCO, following the same methodology and contents of ASCO’s program. The first session was carried out in October 2018, with 12 Spanish teams participating with diverse quality improvement projects. The program counted with ASCO and ECO faculty, constituted by experts in the quality and oncology field. Results: Each QTP Spanish team counted with 2-3 representatives from their hospitals and developed an improvement project, following the methodology of the course, including a problem statement, process map, cause and effect diagram, diagnostic data, aim statement, measures, baseline data, priority/pay-off matrix of possible changes/interventions, change data, next steps/plan for sustainability, among others. The projects were mainly focused on the waiting time reduction in the Emergency Area and from the patient’s visit to the oncologist until treatment administration, burnout reduction on oncology professionals, improvement of the identification and management of complications for cancer patients receiving immunotherapy, improvement of the uniformity in the medical records registry, among others. QTP participants presented their projects’ results on the third and last session of the program in April 2019 with positive outcomes. Conclusions: The QTP’s quality improvement approach allows Spanish teams and the ECO Foundation to enhance the goal of a quality-oriented health care system. ECO will continue pursuing excellence and quality with further initiatives like the QOPI program, the QCP and the QTP.

Implementation of the Quality Training Program in Spain.

e18296 Background: The ECO Foundation is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Since 2015, ECO has been collaborating with ASCO (American Society of Clinical Oncology) in quality initiatives in cancer care, like the QOPI (Quality Oncology Practice Initiative) program and the QOPI Certification Program (QCP). The Quality Training Program (QTP) is a 6-month program with 3 in-person learning sessions that prepares oncology teams to design implement and lead successful quality improvement activities in their practices. In 2018, ECO reached a new agreement with ASCO to implement this program in Spain. Methods: The QTP was developed in Spain by the ECO Foundation in collaboration with ASCO, following the same methodology and contents of ASCO’s program. The first session was carried out on October 2018, with 12 Spanish teams participating with diverse quality improvement projects. The program counted with ASCO and ECO faculty, constituted by experts in the quality and oncology field. Results: The QTP Spanish teams counted with 2-3 representatives from their hospitals. Each team develop an improvement project, following the methodology of the course, including a problem statement, process map, cause and effect diagram, diagnostic data, aim statement, measures, baseline data, priority/pay-off matrix of possible changes/interventions, change data, next steps/plan for sustainability, among others. The projects were mainly focused on the waiting time reduction in the Emergency Area, the waiting time reduction for cancer patients from the visit to the oncologist until treatment administration, burnout reduction on oncology professionals, improvement of the identification and management of complications for cancer patients receiving immunotherapy, improvement of the uniformity in the medical records registry, among others. QTP participants will present the results of their projects on the third and last session of the program, on April 2019. Conclusions: The quality improvement approach followed in the QTP allows Spanish teams and the ECO Foundation to enhance the goal of a quality-oriented health care system. ECO will continue pursuing excellence and quality with further initiatives like the QOPI program, the QCP and the QTP.

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.

QIM19-135: The Quality Oncology Practice Initiative Program: Experience in Spain

Background: Patient quality care is a discipline that has acquired enormous relevance in today’s healthcare. The Quality Oncology Practice Initiative (QOPI) is a referral worldwide in terms of quality for oncology practices. The ECO Foundation is a foundation of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with ASCO to involve Spanish hospitals in the QOPI program. Methods: 6 rounds of data collection have taken place (Fall 2015 to Round 1 2018). Practices had to register online and submit data into the QOPI platform, and the ECO Foundation offered all centers the necessary support. 17 Spanish hospitals have participated in the 6 rounds, and 7 of them have repeated participation. Core and lung cancer modules were completed. Results: During the 6 rounds, 1,877 charts were submitted by the Spanish practices. In most of the rounds, the highest scores were: pathology report confirming malignancy; number of chemotherapy cycles documented; patient consent for chemotherapy; and 5 measures of the lung cancer module. The lowest scores were: chemotherapy treatment summary provided to patient within 3 months of chemotherapy end; chemotherapy treatment summary provided or communicated to practitioner(s) within 3 months of chemotherapy end; smoking/tobacco use cessation counselling recommended to smokers/tobacco users in past year; and tobacco cessation counselling administered or patient referred in past year. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75%, and 100% in the last 3 rounds. For the 7 hospitals that repeated participation, 3 reported an improvement of their global scores. Regarding QOPI Certification, 3 Spanish hospitals 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, these being performed for the first time in Spain in 2017 and 2018, respectively.

The Quality Oncology Practice Initiative program: Experience in Spain.

310 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. ECO Foundation is a collaboration of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with QOPI to involve Spanish hospitals in the QOPI program. Methods: Six rounds of data collection have taken place (Fall 2015 to Round 1 2018). Practices had to register online and submit data into the QOPI platform, and ECO Foundation offered all centers the necessary support. 17 Spanish hospitals have participated in the six rounds, and 7 of them have repeated participation. Core and Lung Cancer modules were completed. Results: During the six rounds, 1877 charts were submitted by the Spanish practices. In most of the rounds, the highest scores were: Pathology report confirming malignancy, Number of chemotherapy cycles documented, Patient consent for chemotherapy and 5 measures of the Lung Cancer module. The lowest scores were: Chemotherapy treatment summary provided to patient within 3 months of chemotherapy end, Chemotherapy treatment summary provided or communicated to practitioner(s) within 3 months of chemotherapy end, Smoking/tobacco use cessation counselling recommended to smokers/tobacco users in past year and Tobacco cessation counselling administered or patient referred in past year. The percentage of participating practices that presented results higher than 70% was successively 64%, 50%, 75% and 100% in the last three rounds. For the 7 hospitals that repeated participation, 3 reported an improvement of their global scores. Regarding QOPI Certification, three Spanish hospitals 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. ECO Foundation will continue pursuing excellence and quality with further activities like the QOPI Certification program and Quality Training Program, these being performed for the first time in Spain in 2017 and 2018 respectively.

1586P - The quality oncology practice initiative program: Experience in Spain

1586P - The quality oncology practice initiative program: Experience in Spain

The Quality Oncology Practice Initiative program: Experience in Spain.

214 Background: Patient care quality is a discipline that is being considered highly important in today’s healthcare. Quality Oncology Practice Initiative (QOPI) is a referral worldwide in terms of quality for oncology practices. The ECO Foundation is a platform of experts representing the major Spanish hospitals involved in the treatment of cancer patients. ECO reached an agreement with QOPI in order to involve Spanish hospitals in the participation of the QOPI program. Methods: Two rounds of data collection were carried out (Fall 2015 and Spring 2016). Practices had to registered on-line and submit data into the platform provided by QOPI. ECO Foundation offers all centres the support of a CRO. 11 Spanish hospitals have participated in the first round and 6 in the second. 4 of them have participated in both rounds. Core and Lung Cancer modules were completed. Results: For the Fall 2015 round, 686 charts were included. In Spring 2016 334 charts were collected. For the first round, highest scores were: Pathology report confirming malignancy, Plan of care for pain, Effectiveness of narcotic, Patient consent, Tobacco cessation counselling, Patient emotional well-being assessed and in the 9 items of the lung cancer module. Lowest scores were: Pain addressed, Smoking status use, Smoking use cessation counselling, Smoking use cessation administered and Height, Weight, and BSA documented. For the Spring 2016 round, the results were similar, but for the items with the highest scores were now included: Chemotherapy intent discussion, Patient consents for chemotherapy, Smoking status documented, Height, Weight, and BSA documented. In Fall 2015, 7 out of 11 practices obtained a global score of over 70%, and in 2016, 3 out of 6. Regarding the 4 hospitals that repeated in both stages,3 reported an improvement of the global scoring in 2016. 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 analyse cancer care in Spain, offering training programs for quality improvement in oncology practices. ECO Foundation will continue pursuing excellence and quality in Spain with future activities like the certification programs and training seminars.

Improving quality of pediatric oncology care via ASCO’s Quality Oncology Practice Initiative (QOPI) program.

212 Background: Pediatric oncologists strive to provide a high quality of care for their patients. American Society of Clinical Oncology (ASCO) developed the Quality Oncology Practice Initiative (QOPI) Program which serves to evaluate institution’s best oncology practices. The program evaluates Core Measures in Disease Modules and Domain Modules. The Disease Modules were not useful in a pediatric practice, however, the Core Measures and Domain Modules were appropriate for evaluating pediatric quality care. Methods: Kaiser Permanente Los Angeles Medical Center Pediatric Oncology participated in the QOPI Spring 2012 Collection. Thirty-five member charts were audited by a registered nurse case manager via the electronic medical record (EMR) for Symptom/Toxicity Management, Care at End of Life, and Core Measures modules over the course of six weeks. Results: Data results revealed areas that needed improvement at LAMC included oncologist’s documentation of chemotherapy treatment and consent, physician and nurse documentation of chemotherapy and disease education, documentation of oral chemotherapy adherence and documentation of fertility preservation. Only two pediatric end-of-life cases met requirements for abstraction during this round of audit. Chart audits were easily abstracted from EMR. The QOPI computer program was easy to use and concise with information and guidelines for measures to be abstracted. QOPI personnel were readily available for any problems or concerns. Conclusions: Participation in the ASCO QOPI Program can serve as a tool to help improve oncology institution’s best practices. The QOPI Program could further expand its disease modules to include more pediatric content such as acute leukemia and neuro-oncology. In addition, participation in this program offers 3-year certification for outpatient hematology-oncology practices (limited to internal medicine at this time) and could serve as your Part IV Maintenance of Certification (limited to internal medicine).

Assessing quality in a rural oncology program using the Quality Oncology Practice Initiative (QOPI).

275 Background: Molokai General Hospital (MGH) is a critical access hospital for 7,400 people on the isolated island of Molokai. It is a small 14 bed medical center that started an outpatient oncology program six years ago. Over this period, 213 patients received care through an innovative telemedicine program partnership with the Queens Medical Center in Honolulu, Hawaii. Methods: Study design was a retrospective chart review. Results: The most common types of cancers seen were breast cancer 57 (26.7%), lung cancer 29 (13.6%), colon cancer 26 (12.2%), prostate cancer 29 (13.6%), lymphoma 8 (3.7%), and liver cancer 3 (1.4%). Cancer patients were almost 80 % minorities; over 55% were native Hawaiians or part Hawaiian. The percentage of Caucasians, Hispanic, and African American were lower than the national averages. Hawaiian 118 (55.3%), Caucasian 43 (20.8%), Filipino 30 (14%), Japanese 17 (7.9%), African American 2 (0.9%), Other Pacific Islanders 2 (0.9%), Hispanic 1 (0.4%) Using national and local benchmarks from QOPI, areas of excellence and deficiency were identified. In 29% of the core measures, MGH did a better job than the urban comparison in Honolulu, Hawaii. For breast and colon cancer, the quality was better than the national QOPI aggregate. Similarly, the symptom care was better than national average. A survivorship program was initiated 2 years ago and treatment summaries were beginning to be sent. Since its start, 45 of the total 213 (21.1%) patients have been enrolled in the Survivorship program. Conclusions: The QOPI program helped review a small rural program which lacks staff and resources for a full time Quality Improvement program. This may be a model for other small programs to check for quality of care.

Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI).

206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]

Quality Oncology Practice Initiative (QOPI): Preliminary results from a Brazilian academic public oncology service.

e16568 Background: The Quality Oncology Practice Initiative (QOPI) is a voluntary program developed by ASCO to aid oncology practices in quality self-assessment and continuous improvement of patient records. It consists of a cyclical, semiannual measurement of the adequacy of several care processes pertaining to some important aspects of patient care. Few academic cancer centers have been QOPI participants in the United States and there aren’t reports to our knowledge of any Latin American Cancer Center adopting this strategy. Methods: This study shows the pilot initiative to implement the QOPI at the ABC School of Medicine, Discipline of Oncology, a large public academic cancer center of Santo André, São Paulo, Brazil. Results: From January 2008 to December 2010, we consecutive selected 37 patients with gastric cancer, 40 with breast cancer, 33 with lung cancer and 40 colorectal cancer. The table below shows the first round of the core QOPI. Conclusions: There are several opportunities for improvement such as assessing and recording of pain and analgesic use, documentation patient consent and of the intent of chemotherapy and providing patients with their chemotherapy summaries. Our current electronic record will be modified to reflect the aforementioned needs in order to improve our results in the following rounds of QOPI program. [Table: see text]

Quality Oncology Practice Initiative Turns Seven

It is fitting that the current issue of Journal of Oncology Practice highlights the ASCO Quality Oncology Practice Initiative (QOPI). Seven years ago, Joseph Simone, MD, then chair of the National Cancer Policy Board of the Institute of Medicine, submitted a modest proposal to ASCO. He suggested the funding of a feasibility study to determine if a small cadre of highly selected oncologists would be willing to voluntarily measure the quality of care they provide and share those results with one another and with their colleagues. The details of Simone's vision and the remarkable history of QOPI are summarized in his commentary. Simone's vision for a quality measurement system has been realized far beyond his initial expectations. QOPI has grown to include more than 500 practices. With the support of ASCO, QOPI remains true to Simone's vision as a voluntary, oncologist-led measurement system designed to encourage practices to regularly monitor and improve the care they provide. Just as a stethoscope helps a physician make a diagnosis, QOPI is a tool that allows practices to identify opportunities to provide better care. QOPI measures processes of care routinely provided in outpatient oncology practices. Measurement alone, however, does not translate into improvement. Although highlighting a flawed process may lead to temporary improvement, benefits are usually short lived. Sustained improvement in a process requires the application of the principles and tools of quality improvement, and the identification and sharing of best practices are often beneficial. Siegel et al define the next step toward Simone's goal of improving adult oncology care. The National Cancer Institute Community Cancer Centers Program (NCCCP) was established as a consortium of independent oncology practices located throughout the country that agreed to work collaboratively to improve performance across the cancer care continuum. The NCCCP's Quality of Care Subcommittee, led by Siegel and working in close collaboration with ASCO, has used QOPI to measure practice performance among 11 NCCCP practices. The collaboration enables centers excelling at particular measures to share their best practices with others, and participants are encouraged to incorporate the new processes into their workflow. The details of the program, along with representative performance data, are included in their article. Blayney et al highlight a successful collaboration between Blue Cross Blue Shield of Michigan (BCBSM) and practicing medical oncologists. Recognizing that some Michigan practices might not be able to participate in QOPI, either because of limited staff or funds to undertake data collection, BCBSM created a program to provide funding for QOPI participation. This approach led to a fourfold increase in participation by medical oncologists in Michigan. In addition, BCBSM has facilitated the creation of the Michigan Oncology Quality Consortium, which, like the NCCCP, will enable oncologists to share best practices. McNiff et al describe another step in the evolution of QOPI. On the basis of feedback from long-term QOPI participants and mounting pressure from payers, ASCO has created the QOPI Certification Program. This program will allow QOPI practices to take the next step in practice improvement. A certified practice will need to achieve a minimum threshold performance on a selected set of QOPI performance indicators and demonstrate that a set of chemotherapy safety standards are in place in the practice. Like the existing QOPI program (which will remain in place), participation in the QOPI Certification Program is voluntary. Dodgion and Greenberg provide an important update on the use of population-based registries to address variation in cancer care. The authors suggest that the rapid adoption of electronic health records in oncology will soon become a source of highly granular and timely clinical information that will lead to the development valuable clinical registries to focus improvement efforts. ASCO has developed the Breast Cancer Registry Pilot Program, which uses a Web-enabled application based on the ASCO Breast Cancer Treatment Plan and Summary template. This methodology may eventually replace the current approach to QOPI data collection, which requires manual retrospective medical record abstraction and data entry. The QOPI program is being increasingly recognized as an important example of a medical subspecialty society that has responded quickly and successfully to the national need to address quality of care. Schneider, a senior scientist at the RAND Corporation and co-investigator of the earlier ASCO-sponsored National Initiative on Cancer Care Quality, provides the final commentary in this issue, framing the QOPI program in the context of other national physician organization–sponsored quality initiatives.

Preliminary evaluation of quality of psychosocial care indicators: Results from the Quality Oncology Practice Initiative (QOPI)

6534 Background: To gauge the opportunity for improvements in psychosocial care, ASCO's QOPI program tested two new quality indicators in 2008. Similar to other QOPI indicators, these were presented as questions to be answered (yes/no) based on review of patient records: 1) was current emotional well-being assessed within one month of a first visit with a medical oncologist; and 2) was action taken for a patient identified as having a problem with emotional well-being. In addition to examining variability on these indicators, performance of assessments of pain (another QOPI indicator) and emotional well-being were directly compared. Methods: Practices participating in the Spring 2008 QOPI data collection round were included if they reported results for psychosocial care indicators with at least 40 patients. This criterion was met by 96 practices, which provided information on 9,045 patient records. Results: Across practices, rates of assessment of emotional well-being ranged from 0–100% (Mdn = 78%), with 27% of practices achieving rates &lt; 50%. In contrast, rates of assessment of pain ranged from 12–100% (Mdn = 88%), with 9% of practices achieving rates &lt; 50%. Mean rates of assessment of pain (83%) and emotional well-being (70%) differed significantly across practices (t = 4.61, p &lt; 0.001). Problems in emotional well-being were documented in 10% of records. Among these records, rates of documentation of action taken ranged from 0–100% (Mdn = 73%, M = 72%), with 26% of practices achieving rates &lt; 50%. Conclusions: Wide variability in the documentation of psychosocial care was evident among the practices surveyed, with at least 26% showing substantial opportunity for improvement (i.e., performance &lt; 50%). Additional findings suggest that, to date, efforts to promote routine symptom assessment have been more successful for pain than for emotional well being. No significant financial relationships to disclose.

QOPI, EHRs, and Quality Measures

We read with great interest the article by Neuss et al (“A Process for Measuring the Quality of Cancer Care: The Quality Oncology Practice Initiative”) in the September 1, 2005, Journal of Clinical Oncology, and the Quality Oncology Practice Initiative (QOPI) article from the January 2006 JOP. From the perspectives of an electronic health record (EHR) vendor and a practicing oncologist, we found the reports on the QOPI system timely and laudable, and the results are encouraging. That the indicators largely improved between the two survey rounds was encouraging, especially given that the project is in its infancy. What was disheartening, however, was that the capability for collecting quality indicators using EHR systems was entertained neither in the conception of the study nor in the associated article discussions. While this is understandable given the limited penetration of EHR systems, it neglects considerations for scaling and evolving the QOPI program. Oncology-specific EHR systems are currently available and are capable of providing a robust infrastructure for support of quality-improvement projects. These systems will likely render manual data abstraction and collection methods obsolete, and help reduce the $1,000 per-practice cost for the QOPI assessment—a cost that increases dramatically when applied to a nationwide system. Furthermore, the use of EHR systems in oncology will undoubtedly increase over time, and their costs can be offset by their potential for promoting efficiency, reducing medical errors, and enhancing quality care. Initiatives launched by the Office of the National Coordinator for Health Information Technology, the promotion of the Oncology Demonstration Programs by Centers for Medicare and Medicaid Services, and proposed legislation encouraging Pay for Performance, as well as patient demands, all suggest that widespread adoption of EHR systems by oncologists is imminent. Advantages of embedding quality measures into the core of an EHR system abound. Indicators can be “calculated” based on data entered during the course of routine care, and reports of quality could become routine. Quality for all patients, not just a random few, could be tracked and quantified in real time. Using EHR systems, aggregation across practices along with centralized collection, comparison, and analysis is more readily supported. The same may be true for methods of abstracting, reviewing, auditing, and identifying other leading and lagging quality indicators. By promoting and standardizing QOPI measures, data from disparate EHR systems could be compared, and otherwise leveraged in support of quality management. Perhaps most importantly, an EHR can help promote the very quality it is responsible for measuring, by enforcing rules such as “no chemotherapy administration unless a consent is present.” We believe that quantification of most of the 11 QOPI indicators is already possible using commercially available oncology-specific EHR systems. However, as the QOPI project evolves, the following EHR-specific criteria would add significantly to the “ideal and practical” criteria introduced by the authors: Coordination and standardization of indicators among all the stakeholders, including professional societies, insurers, payers, patient advocacy groups, governmental organizations, accreditation bodies, and the practices themselves Consideration for ease of “calculating” the indicator from measures already present in an EHR. For example, whether an explicit statement of the patient's staging has been entered is far easier to “calculate” and validate than whether there was appropriate use of chemotherapy and hormonal therapy for a subset of breast cancer patients It is vital that all stakeholders agree upon a standardized nomenclature, lest the field degenerate into a “Tower of Babel.” We agree with the authors that a process for gathering data concerning the quality of oncology care in individual practices needs to be expeditiously designed and implemented. The QOPI system may indeed allow rapid feedback of performance data for each of the selected indicators, but probably not as efficiently and rapidly as a QOPI-equipped EHR system. In an era where EHRs are coming of age, the time to incorporate indicators into the core of such systems is now. EHR vendors have an interest in collaborating in the development and adaptation of current indicators, but the responsibility of equipping EHRs to measure, track, and enhance quality in the oncology practice belongs to all of us.