Successful implementation of a quality improvement intervention towards a QOPI-compliant breast cancer center in Mexico.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 59-59
Author(s):  
Omar Peña-Curiel ◽  
Cynthia Villarreal-Garza ◽  
Mauricio Canavati-Marcos ◽  
Karen M. Velazquez-Ayala ◽  
Janeth Castro-Carrasco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Cancer Center ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Microsoft Word ◽  
Pdsa Cycle ◽  
Oncology Practice ◽  
First Time

59 Background: Ensuring quality of care in our breast cancer center (BCC) at Hospital Zambrano Hellion in Monterrey, Mexico has been one of the main objectives since its commencement in 2016. To achieve this goal, we evaluated our compliance to ASCO’s Quality Oncology Practice Initiative (QOPI) 84 breast cancer related metrics as a part of a quality improvement (QI) project undertaken during the 2018 Quality Training Program (QTP) in Alexandria, VA. Methods: We established a multidisciplinary QI team engaged in data acquisition, process improvement and implementation in our BCC. We developed a Microsoft Word medical record template and established a new “first time visit” model to achieve our objective of 80% documentation rate of 13 identified reasonably achievable QOPI metrics. Monthly Plan-Do-Study-Act cycles were conducted for 6 months from August through December 2018. Results: After a sample data abstraction of 20 patients’ medical records, our baseline QOPI-compliance resulted in 40/84 QOPI metrics being met by our BCC program. The remaining 44/84 were distributed in two categories, the first 13/44 were labeled as “done/not documented” metrics, and the second set of 31/44 metrics were labeled as “not done/not documented” metrics given they were not performed at all. We approached the 13/44 “done/not documented” metrics for this project based on our priority matrix. After our QI intervention, we surpassed our objective by the third PDSA cycle. Furthermore, by March 2019 we reached 95% cumulative compliance of those metrics. Conclusions: The development of a systematic QI approach enhanced our BCC QOPI-compliance in 13 reasonably achievable metrics to 95% over a 6-month period. Currently, we are targeting the remaining 40/84 metrics to ultimately adhere to all breast cancer QOPI standards. To our knowledge, we are the first Mexican BCC pursuing a QOPI-compliant practice through ASCO’s QTP initiative.

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

2020 ◽  
Vol 16 (11) ◽  
pp. e1406-e1411
Author(s):  
Omar Peña-Curiel ◽  
Cynthia Villarreal-Garza ◽  
Mauricio Canavati ◽  
Karen Marlene Velazquez-Ayala ◽  
Janeth Castro-Carrasco ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Current Model ◽  
Cancer Center ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Consultation Process ◽  
Microsoft Word ◽  
American Society ◽  
Oncology Practice

INTRODUCTION: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

scholarly journals Improving Documentation of Distress in Veteran Patients for Hematology/Oncology Clinics

2019 ◽  
Vol 15 (5) ◽  
pp. e475-e479
Author(s):  
Samantha Bodner ◽  
Arpan Patel ◽  
Priya K. Gopalan
Keyword(s):  
Quality Improvement ◽  
Medical Records ◽  
Medical Center ◽  
Quality Improvement Intervention ◽  
Pdsa Cycle ◽  
Patients Experience ◽  
Cancer Network ◽  
Improvement Intervention

The purpose of this quality improvement study was to improve physician documentation of distress in medical records of hematology/oncology veteran patients at the Malcolm Randall Veteran Affairs (VA) Medical Center hematology/oncology fellows’ clinic in Gainesville, Florida. Before this intervention, the VA hematology/oncology fellows were not documenting patient distress in medical records. The quality improvement intervention was executed through the use of Plan-Do-Study-Act (PDSA) cycles with an ultimate goal of 50% documentation rate. Physician charts were audited to investigate official documentation of distress in patient charts. Physician documentation of distress was 14% in the first PDSA cycle, 21% in the second PDSA cycle, and 36% in the third PDSA cycle. Additional data on distress in hematology/oncology veteran patients were collected using the National Comprehensive Cancer Network Distress Thermometer and Problem List for Patients. Analysis of findings indicated that 42% of 88 patients experienced distress. Findings also suggest that hematology/oncology veteran patients experience specific sources of distress, notably fatigue and pain. These patients have presumably undergone unique experiences that can result in distress that providers should follow-up with in medical charts. Although this intervention has proven challenging to fully implement, standardizing patient distress in patient medical records has the potential to improve the quality of care provided by hematology/oncology physicians.

scholarly journals Comparison of 2 Quality-of-Life Questionnaires in Women Treated for Breast Cancer: The RAND 36-Item Health Survey and the Functional Living Index–Cancer

2005 ◽  
Vol 85 (9) ◽  
pp. 851-860 ◽  
Author(s):  
Rick W Wilson ◽  
Lorraine M Hutson ◽  
Deborah VanStry
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Survey ◽  
Convergent Validity ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Global Quality Of Life ◽  
Index Cancer

Abstract Background and Purpose. A variety of health status questionnaires have been used in physical rehabilitation studies involving women with breast cancer, but the usefulness of these questionnaires as measures of physical, mental, and social well-being has not been firmly established in this population. This study was conducted to assess the convergent and discriminative properties of the RAND 36-Item Health Survey and the Functional Living Index–Cancer (FLIC). Subjects Both questionnaires were administered concurrently to 110 outpatients treated surgically for breast cancer at a National Cancer Institute–designated Comprehensive Cancer Center. Methods Bivariate correlations and a multi-trait–multi-method matrix were used to evaluate convergent validity between summary and subscale scores from both questionnaires. Discriminative validity was assessed by testing for expected differences between women who were treated for breast cancer with and without secondary lymphedema. Results Correlations between overall quality-of-life scores produced by both questionnaires were modest, indicating that the instruments focus on somewhat different aspects of health-related quality of life. Global quality-of-life and physical well-being scores were lower among women with lymphedema secondary to breast cancer. The FLIC demonstrated greater sensitivity to group differences in emotional well-being. Discussion and Conclusion The results suggest that neither questionnaire can be replaced by the other in studies of women treated for breast cancer. Both questionnaires were able to distinguish physical functioning deficits in women with lymphedema secondary to breast cancer, but symptom- or treatment-specific measures may be required to assess more subtle difficulties related to the emotional aspects of health and functioning in this population.

Proposed Agenda for the Measurement of Quality-of-Care Outcomes in Oncology Practice

1999 ◽  
Vol 17 (8) ◽  
pp. 2614-2614 ◽  
Author(s):  
Jeanne S. Mandelblatt ◽  
Patricia A. Ganz ◽  
Katherine L. Kahn
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Cancer Care ◽  
The United States ◽  
Leadership Role ◽  
Institute Of Medicine ◽  
Oncology Practice ◽  
The Impact

ABSTRACT: Cancer is an important disease, and health care services have the potential to improve the quality and quantity of life for cancer patients. The delivery of these services also has recently been well codified. Given this framework, cancer care presents a unique opportunity for clinicians to develop and test outcome measures across diverse practice settings. Recently, the Institute of Medicine released a report reviewing the quality of cancer care in the United States and called for further development and monitoring of quality indicators. Thus, as we move into the 21st century, professional and regulatory agencies will be seeking to expand process measures and develop and validate outcomes-oriented measures for cancer and other diseases. For such measures to be clinically relevant and feasible, it is key that the oncology community take an active leadership role in this process. To set the stage for such activities, this article first reviews broad methodologic concerns involved in selecting measures of the quality of care, using breast cancer to exemplify key issues. We then use the case of breast cancer to review the different phases of cancer care and provide examples of phase-specific measures that, after careful operationalization, testing, and validation, could be used as the basis of an agenda for measuring the quality of breast cancer care in oncology practice. The diffusion of process and outcome measures into practice; the practicality, reliability, and validity of these measures; and the impact that these indicators have on practice patterns and the health of populations will be key to evaluating the success of such quality-of-care paradigms. Ultimately, improved quality of care should translate into morbidity and mortality reductions.

Assessing the quality of breast cancer care in cancer center hospitals in Japan.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e16566-e16566 ◽  
Author(s):  
T. Higashi ◽  
F. Nakamura ◽  
H. Mukai ◽  
T. Sobue ◽  
E. Mekata ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Cancer Center ◽  
Breast Cancer Care

Developing a virtual collaborative to facilitate palliative care and quality improvement learning in oncology.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 252-252 ◽  
Author(s):  
Arif Kamal ◽  
Kristen McNiff ◽  
Ann A. Prestrud ◽  
Dale Lupu ◽  
Molly Gavigan ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Best Practices ◽  
Technology Development ◽  
Evidence Base ◽  
Evaluation Methods ◽  
Quality Improvement Intervention ◽  
Learning Collaborative ◽  
Care Needs ◽  
Oncology Practice

252 Background: Despite a strong evidence base and increasing calls for integration, oncologists find it difficult to deliver primary palliative care concurrent with standard oncology care. Solutions that promote practical integration of palliative care in oncology are needed. In an AHRQ-funded pilot, ASCO and the American Academy of Hospice and Palliative Medicine are developing the Virtual Learning Collaborative (VLC) to develop and test a scalable model for quality improvement and dissemination of best practices in palliative care within the oncology setting. Methods: The VLC will be a web-based learning and collaboration system built upon existing ASCO technology resources. We will select at least 25 oncology practices to participate in regular, facilitated learning sessions, collaborative discussions, and sharing of best practices. The VLC will equip each practice with the knowledge, tools, and coaching to select, test, and adopt a quality improvement intervention relevant to their own palliative care needs. Development of the VLC is ongoing; oncology practices begin participation in Spring 2014. Results: We will assess the VLC using protocol-driven evaluation methods common to technology development, quality improvement, implementation science, and educational initiatives. VLC usability, feasibility, and acceptability will be assessed through surveys of participating practices and focus groups. Longitudinal changes in conformance to palliative care metrics will be assessed using ASCO’s Quality Oncology Practice Initiative (QOPI) system. We will use mixed qualitative and quantitative evaluation methods to assess ongoing changes in clinician knowledge and self-efficacy in applying palliative care principles. Conclusions: We aim to develop and test a novel method for facilitating quality improvement and palliative care learning in oncology. Through this pilot, we will refine the VLC for implementation in the greater oncology community. Ultimately, this effort supports other ASCO and AAHPM quality improvement initiatives focused on clinician education and dissemination of best practices.

Quality of care improvement in breast and lung cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 252-252
Author(s):  
Douglas D. Letson ◽  
Johnathan M. Lancaster ◽  
Alberto Chiappori ◽  
John W. Peabody ◽  
Lisa DeMaria ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Clinical Decision Making ◽  
Clinical Performance ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Simulated Patients ◽  
Cancer Center ◽  
Serial Measurement

252 Background: Despite the growing call for use of guidelines in cancer care, adherence to clinical pathways and clinical care transformation is a challenge. Moffitt Cancer Center (MCC) has addressed this challenge, in multiple service lines, using its clinical pathways and serial measurement in a broad-based initiative to improve quality of clinical care. Methods: Moffitt launched an initiative focused on quality and improvements in care using Clinical Performance and Value (CPV) vignettes to measure multiple aspects of quality including: clinical decision-making, pathway adherence and appropriate utilization of tests/procedures. The CPVs—simulated patients cared for by providers on-line—are based upon the Moffitt Clinical Pathways. CPVs are given serially to benchmark, motivate providers, and provide confidential individual feedback. Data have been collected every 4 months since mid-2013. We report on three rounds in breast cancer and two rounds in lung cancer. Results: A total of 18 providers at MCC completed the breast cancer CPVs and 19 providers at MCC completed the lung cancer CPVs. Overall scores improved significantly and pathway adherence improved significantly for staging work-up and chemotherapy between rounds 1 and 3 for breast cancer (Table). Conclusions: Adherence to Moffitt Clinical Pathways for breast and lung cancer, using serial measurement and feedback with CPVs, improved across multiple providers and two diseases. This may have potential to transform practice. [Table: see text]

The prevalence and pattern of chemotherapy-induced peripheral neuropathy (CIPN) among women with breast cancer receiving care in a large community oncology practice.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 80-80
Author(s):  
Natalie Brooke Simon ◽  
Michael A. Danso ◽  
Thomas Alberico ◽  
Ethan M. Basch ◽  
Antonia Vickery Bennett
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
African American ◽  
Health Status ◽  
Global Health ◽  
Symptom Severity ◽  
Community Oncology ◽  
The Mean ◽  
Oncology Practice

80 Background: CIPN is a common side effect of taxane-based chemotherapy agents. This study examined the prevalence, severity, and risk factors of CIPN and its impact on quality of life (QOL) among women treated for breast cancer in a large U.S. community oncology practice. Methods: In this cross-sectional survey study, women previously treated with taxane-based chemotherapy for early stage breast cancer completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), breast cancer module (QLQ-BR23) and CIPN module (QLQ-CIPN20). Each subscale is scored 0-100 where higher scores indicate better function or greater symptom severity. Clinical data were abstracted from the medical record. Bivariate analyses were conducted to test pre- specified hypotheses. Results: 126 women with mean age 56.7 years (SD = 11.8) were stage I-II (79.4%) or stage III (20.6%) at the time of the survey; 65.1% were White and 27.8% were Black or African American. 73.0% of women reported they had CIPN. The mean time since last taxane chemotherapy cycle was 144.9 weeks (SD = 112.9). The mean (SD) score of QLQ-C30 global health status/QOL was 77.0 (20.3) and physical function was 85.7 (17.1). QLQ-CIPN20 mean scores for the sensory, motor, and autonomic subscales were 18.9 (23.1), 18.6 (18.7), and 17.1 (21.8), respectively. Presence of CIPN was associated with patient referral and visitation to a neurologist or pain specialist (p < 0.05). CIPN symptom severity was negatively correlated with global health status/QOL and physical and role functioning (range of r= -0.46 to -0.72). Further, it was not associated with age, body mass index, diabetes, or cumulative taxane dosage, but was greater for Black or African American patients versus White patients (e.g., sensory: 28.6 vs 14.5, p < 0.002). CIPN sensory impairment was marginally greater for patients treated with paclitaxel compared to docetaxel (23.3 vs 15.6, p < 0.06). Conclusions: CIPN was prevalent in this community oncology practice and significantly impacts function and QOL. These data highlight the importance of developing methods to mitigate CIPN.

Quality of information addressing treatment options for women with breast cancer on NCI cancer center websites.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e18002-e18002
Author(s):  
Caleb Dulaney ◽  
Daniel Victor Wakefield ◽  
Gabrielle Betty Rocque ◽  
Jennifer F. De Los Santos
Keyword(s):  
Breast Cancer ◽  
Treatment Options ◽  
Cancer Center ◽  
Quality Of Information
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