scholarly journals Evolution of the Quality Oncology Practice Initiative Supportive Care Quality Measures Portfolio and Conformance at a Veterans Affairs Medical Center

2013 ◽  
Vol 9 (3) ◽  
pp. e86-e89 ◽  
Author(s):  
Ryan D. Nipp ◽  
Michael J. Kelley ◽  
Christina D. Williams ◽  
Arif H. Kamal
Keyword(s):  
Quality Improvement ◽  
Supportive Care ◽  
Medical Center ◽  
Quality Measures ◽  
Veterans Affairs ◽  
Care Quality ◽  
Processes Of Care ◽  
Treatment Processes ◽  
Standardized Documentation ◽  
Oncology Practice

Most Quality Oncology Practice Initiative quality measures assess diagnosis or treatment processes of care and not supportive care. The authors demonstrate the necessity for standardized documentation methods and quality improvement efforts that remain commensurate with the increasing portfolio of supportive care measures.

The evolution of supportive care quality measures portfolio and conformance.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 259-259
Author(s):  
Ryan D. Nipp ◽  
Michael J. Kelley ◽  
Christina D. Williams ◽  
Arif Kamal
Keyword(s):  
Supportive Care ◽  
Cancer Care ◽  
Quality Measures ◽  
Well Being ◽  
Care Quality ◽  
Chi Square ◽  
Treatment Measures ◽  
Diagnostic Modalities ◽  
Oncology Practice ◽  
Data Collections

259 Background: A growing set of quality measures is being implemented to evaluate all components of cancer care ranging from diagnosis through the end-of-life (EOL). With an increasing emphasis from ASCO and others on the regular delivery of supportive care principles throughout the cancer trajectory, we investigated our longitudinal Quality Oncology Practice Initiative (QOPI) data to understand the trends in supportive and EOL measures. Methods: We performed twice-yearly QOPI data collections from 2007 through Spring 2012 using chart review of the Durham Veterans Administration (VA) outpatient oncology clinic, staffed by VA and Duke faculty as well as Duke fellows. QOPI measures were categorized as non-treatment related supportive care (SC) (NTSC), treatment-related SC (TSC), diagnostic (D), or therapeutic (T). Descriptive statistics and chi square were used to compare longitudinal conformance. Results: The majority of QOPI measures assess processes of chemotherapy treatment (49.1% T and 11.1% TSC) or diagnostic modalities (21.1% D). Measures targeting NTSC are few (18.6%), but increased from two SC measures in 2007 to eight in Spring 2012, including the addition of two EOL measures. Over the five years, average conformance to NTSC, TSC, D, and T measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (p<0.001). Within the NTSC measures, emotional well-being, and constipation assessment were least documented (41.0%, and 46.3% respectively). In Spring 2012, SC measure conformance (76.0%) remained significantly lower than D measure conformance (91.5%) (p<0.001). Potential explanations include heterogenous and non-standardized ways to document non-treatment measures despite an increasing emphasis within cancer care on supportive and palliative care. Conclusions: Most QOPI quality measures assess diagnosis or treatment processes of cancer care. Aggregate conformance to the NTSC measures was lower than other categories over five years. This disparity persists in the latest 2012 collection, and novel SC measures have been added. The differential conformance demonstrates the necessity of quality improvement efforts that stay commiserate with the increasing portfolio of SC measures.

What type of feedback to clinicians best improves conformance to supportive care quality measures?

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 102-102
Author(s):  
Arif Kamal ◽  
Amy Pickar Abernethy ◽  
Janet Bull ◽  
Jonathan Nicolla ◽  
Joseph Kelly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Supportive Care ◽  
Symptom Assessment ◽  
Quality Measures ◽  
Care Quality ◽  
Quality Data ◽  
Improvement Project ◽  
Edmonton Symptom Assessment Scale ◽  
Comparative Feedback

102 Background: Supportive care is under-addressed in oncology and an important area for quality improvement. Regular, directed feedback is an important component of effective quality management. What type of feedback yields the highest conformance to supportive care measures? Methods: Within the Carolinas Palliative Care Consortium, we conducted a series of three PDSA cycles, each one month-long, to evaluate various types of clinician-directed feedback on conformance to two supportive care measures. We collected data using a web-based, mobile health platform called QDACT-PC (Quality Data Collection Tool for Palliative Care). Every four weeks, feedback to clinicians on performance was changed in a stepwise fashion, from “no feedback” to “personal feedback” to “comparative feedback” (personal conformance compared to the rest of the Consortium). We monitored weekly changes to conformance to two quality measures: documentation of timely management of constipation and dyspnea. To meet the measures, symptoms with intensity of >3/10 on the Edmonton Symptom Assessment Scale required documentation of intervention within 24 hours. Conformance rates were calculated and compared to a historical baseline. Results: 23 providers participated in this quality improvement project, which spanned 465 patient encounters across 104 unique patients. Baseline data generated from 3/2008-10/2011 demonstrated baseline conformance to the dyspnea and constipation measures at 6% (27/457) and 4% (14/398), respectively. After addition of an electronic, prospective quality monitoring system alone (QDACT-PC), conformance increased to 93% (42/45) and 92% (23/25), respectively. With personalized, weekly feedback, these rates increased to 94% for dyspnea and 100% for constipation. Feedback comparing personal performance to the average of the rest of the Consortium further increased this to 100% for both. Conclusions: Regular, weekly feedback on performance increases conformance to supportive care quality measures. Adding comparative feedback versus other peers solidifies this effect. Duration of the effect is being evaluated.

Quality improvement strategies in medical oncology: A qualitative analysis from a scoping review.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 203-203
Author(s):  
Bryan B. Franco ◽  
Laavanya Dharmakulaseelan ◽  
Simron Singh ◽  
Adam E. Haynes ◽  
Brian M. Wong ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Scoping Review ◽  
Medical Oncology ◽  
Qualitative Content Analysis ◽  
Care Quality ◽  
Institute Of Medicine ◽  
Systematic Assessment ◽  
Processes Of Care ◽  
Outcomes Of Care ◽  
The Impact

203 Background: In 2001, the Institute of Medicine (IOM) outlined imperatives to improve quality of care. Quality improvement (QI) has since become essential to cancer care but barriers still exist to the publication of and participation in QI initiatives, including limited recognition for QI and uncertainty with methodologies. We sought to identify strategies used in QI in scholarly medical oncology literature to provide practical guidance for QI. Methods: We conducted a scoping review using Arksey and O’Malley’s framework. A search of EMBASE and MEDLINE databases found 48,186 unique English citations published between January 2001 and August 2014. We utilized an iterative process to refine the inclusion criteria and two reviewers independently reviewed abstracts, resulting in the inclusion of 270 articles. The reviewers then extracted text segments relevant to QI strategies. A qualitative content analysis approach was used to accurately analyze and summarize this process-oriented data. Results: Fifty-four unique QI strategies identified were used alone or in combination to improve structures or processes of care. Five content categories of strategies that targeted structures of care emerged: 1) more methodical approaches (eg, lean thinking, supply-demand analyses), 2) participatory action research and similar strategies, 3) infrastructure to promote health care provider collaboration, 4) application or improvement of information technology (IT), and 5) progression towards a systematic assessment of all patients’ needs. We identified three categories of QI strategies for processes of care: 1) improving patient-clinician relationships or communications, 2) care navigation, and 3) telehealth. Conclusions: Our review identifiedQI strategies in published literature. Strategies were consistent with and expanded on the IOM’s redesign imperatives such as effective use of IT, development of better teams, and care coordination. Identification of strategies provides professionals with tools to engage in QI and may encourage support and recognition for QI. Future studies should examine the impact of different QI strategies on outcomes of care in oncology.

A patient-centered, symptom-focused qualified clinical data registry (QCDR) as a framework to guide quality improvement.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 253-253
Author(s):  
Deborah L. Struth ◽  
Gail Mallory ◽  
Michele Galioto
Keyword(s):  
Quality Improvement ◽  
Performance Improvement ◽  
Implementation Strategies ◽  
Treatment Phase ◽  
Quality Measures ◽  
Care Quality ◽  
Practice Change ◽  
Patient Centered ◽  
Quality Reporting ◽  
Healthcare Improvement

253 Background: Clinically meaningful quality measures have been identified as a catalyst for healthcare improvement and better patient outcomes. Amidst rapidly changing quality reporting and re-imbursement schema, eligible providers struggle to choose a portfolio of measures across multiple registries that will demonstrate the value of their practice to consumers and payers. It is critical that a roadmap to quality improvement be evident to registry users. Utilizing the Model for Improvement developed by the Associates in Process Improvement and adapted to health care by the Institute for Healthcare Improvement, a framework to guide performance improvement was developed and incorporated into an oncology specific QCDR for PQRS reporting. Methods: Fourteen patient-centered quality measures with a focus on cancer related symptom assessment and intervention were piloted and tested in 40 practices and incorporated into the Oncology Nursing Society (ONS)/CE City QCDR. Six measures focus on the active treatment phase of cancer care and eight on breast cancer survivorship. The registry platform was designed with capabilities for tracking of data over time, goal setting, benchmarking, and providing suggested performance improvement (PI) activities. A technical expert panel (TEP) was convened to develop a model to guide PI activities to address QCDR identified practice gaps. Results: A quality improvement framework was developed to help QCDR subscribers answer the question “How Do I Improve” and was incorporated into the ONS/CE City QCDR platform. This framework provides the subscriber with the education and training necessary to improve care through use of quality improvement tools and implementation strategies aimed at practice change. Conclusions: It is essential that measures be incorporated into an infrastructure that provides opportunities for the assessment and improvement of care quality provided by practices. The QCDR can act as a means to drive performance improvement along with supporting quality measurement for PQRS and Meaningful Use reporting. The “How Do I Improve” Framework developed as part of the ONS/CE City QCDR platform provides a model to accomplish this goal.

scholarly journals Re-Engineering a Small Oncology Practice for Quality Using the ASCO Quality Oncology Practice Initiative

2013 ◽  
Vol 9 (3) ◽  
pp. 169-170 ◽  
Author(s):  
Carolyn B. Hendricks
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
Quality Measures ◽  
Future Challenges ◽  
Oncology Practice

The field of quality improvement is expanding rapidly, and small oncology practices need to adapt and rise to future challenges. Additional quality measures from ASCO and other organizations will likely focus on palliative care, the Top Five, and electronic measures.

A chemotherapy privileging process for advanced practice providers at an academic medical center

2019 ◽  
Vol 26 (1) ◽  
pp. 116-123
Author(s):  
Michelle A Carrasquillo ◽  
Tyler A Vest ◽  
Jill S Bates ◽  
Aimee Faso ◽  
Jessica Auten ◽  
...  
Keyword(s):  
Supportive Care ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Assistants ◽  
Advanced Practice ◽  
Training Process ◽  
Academic Medical ◽  
The Creation ◽  
Oncology Practice

Purpose Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. Methods An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. Results Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. Conclusion The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.

Toward proven and prioritized quality measures: Which ASCO QOPI and other supportive care measures associate with improved quality of life (QOL)?

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 165-165
Author(s):  
Arif Kamal ◽  
Janet Bull ◽  
Amy Pickar Abernethy
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Supportive Care ◽  
Cancer Patients ◽  
Clinical Care ◽  
Performance Status ◽  
Quality Measures ◽  
Well Being ◽  
Care Quality ◽  
The Impact

165 Background: An expanding array of quality measures, including the Quality Oncology Practice Initiative (QOPI) metrics, is being developed for oncology. To date, evidence demonstrating the impact of each metric on outcomes, ultimately aiding in prioritization of individual measures, remains immature. We investigated the relationship between conformance with quality measures and higher patient QOL among cancer patients receiving palliative care. Methods: A comprehensive systematic review of PUBMED and the gray literature (1995-2012) identifed all described supportive care quality measures. Patients receiving palliative care in 4 community-based programs were entered into a longitudinal quality registry; analyses focused on cancer patients registered between 6/08-10/11. To find predictors of higher QOL, conformance cohorts were examined for demographic variables, performance status (measured by palliative performance scale, PPS) and provider estimation of prognosis and included in univariate and multivariate regression. Results: The systematic review yielded 303 quality measures. Of these, 18 measures, representing components of the ASCO QOPI, Hospice PEACE, and Cancer-ASSIST measure sets, were evaluable using registry data. 460 cancer patients were included. 60% of patients had weeks to 6 months expected prognosis. Among QOPI measures, conformance with two measures was significantly associated with better QOL: constipation assessment at time of narcotic prescription and emotional well-being assessment (both p<0.05). Other significant findings were conformance with screening of symptoms at first visit (p=0.017), timely treatment for uncontrolled dyspnea (p=0.005), and assessment of fatigue (p=0.007). In a multivariate model predicting higher QOL, measures involving emotional well-being assessment (OR 1.60; p=0.026) and screening of symptoms (OR 1.74, p=0.008) remained significant. Conclusions: Clinical care that conforms to quality measures reflecting regular symptom and emotional assessment is significantly associated with better patient experiences (QOL) and should be prioritized in quality assessment efforts.

Clinical pathways: An emerging tool for quality improvement.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 222-222
Author(s):  
Hillary Kleiner ◽  
Francesca Pirog
Keyword(s):  
Quality Improvement ◽  
Guideline Adherence ◽  
Clinical Pathways ◽  
Quality Measures ◽  
Care Quality ◽  
Management Tool ◽  
Adherence To Guidelines ◽  
Appropriate Care ◽  
Organizational Quality ◽  
The Impact

222 Background: Clinical pathways have emerged as a tool for payers to encourage provider adherence to evidence-based care. Avalere sought to understand how oncology pathways are incorporated into broader organizational quality improvement initiatives and what impact they have on care quality. Methods: Avalere conducted white and grey literature searches to assess pathways used in quality improvement initiatives. The research was augmented by interviews with leading pathways organizations. Results: Research suggests that pathways can play the following roles in quality improvement: Ensure Adherence to Guidelines. Pathways are typically built on guidelines. Guideline adherence thresholds improve care quality by incentivizing appropriate care. While pathway adherence thresholds are typically set at 80%, little research has been conducted on whether adherence thresholds have improved guideline adherence. Ensure Adherence to Quality Measures. Quality metrics can be tied to pathway adherence, which in turn can also incentivize appropriate care. Quality measures tied to pathways can be used as a risk-mitigation and management tool for providers that assume more risk. Improve Patient Outcomes by Reducing Treatment Variability. Some clinical pathways programs have been shown to improve outcomes. Between 2010-2012, after implementing breast, colon and lung cancer pathways, US Oncology and Aetna experienced 1.2 inpatient days for patients vs. 2.1 prior to launch, as well as a 10% ER visits in the pathways group vs. 14% in the control group. Enable Comparative Outcomes Assessment. CPs could allow for benchmarking of outcomes over time. Treatment choices could be tracked through pathways and the outcomes could potentially be matched to those choices. Conclusions: While pathways have been shown to play a role in quality improvement, initial results have been short-term and isolated. To ensure that pathways can be a viable part of organizational quality improvement, additional research must be conducted on the impact of pathways on outcomes. Additionally, given the lack of pathway transparency and consistency there is a need for increased oversight to ensure that pathways are appropriately incentivizing adherence to guidelines and quality measures.

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