scholarly journals The Value of New Fields in the Medical Record for Quality Improvement

2021 ◽  
Author(s):  
Theodore Poufos ◽  
Georgios Rigakos ◽  
Stefanos Labropoulos ◽  
Kalliopi Stathaki ◽  
Ioanna Theodorakopoulou ◽  
...  
Keyword(s):  
Medical Record ◽  
Treatment Plan ◽  
Healthcare Delivery ◽  
Well Being ◽  
Psychosocial Assessment ◽  
Paper Medical Record ◽  
American Society ◽  
Oncology Practice ◽  
Quality In Healthcare

ABSTRACT Introduction Quality in healthcare delivery is important for the safety and experience of patients with cancer. Effective documentation is an integral component of quality improvment, and accurate documentation can be affected by prompts in the medical record, potentially improving quality of services. Methods The Contemporary Oncology Team (COT) is a Greek private oncology practice that participated in the American Society of Clinical Oncology's (ASCO's) Quality in Oncology Practice Initiative (QOPI). Between 2014 and 2019, COT implemented changes in its paper patient medical record, in order to improve quality of care and documentation. Fields regarding pain, emotional well-being and psychosocial assessment, discussions with the patient and consent about treatment and disease, medication details and cumulative dose, treatment goals, side-effect grading, pregnancy screening, treatment adherence and anticipated duration were added. In this report, we present the association of these improvements with COT performance in QOPI. Results Pain and emotional well-being assessment and documentation were significantly improved by the development of a structured patient follow-up form. In contrast, the assessment of fertility issues, tobacco use, and the documentation of treatment plan and intent did not present a drastic change, because COT performance was already above QOPI average. Conclusion A thorough reform of COT paper medical record according to QOPI standards improved QOPI scores, but more importantly effected a shift in the team's culture to safer and more standardized quality based care.

Improving quality of cancer care: Lessons learned from the journey towards QOPI Certification.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 263-263
Author(s):  
Nafisa Abdelhafiez ◽  
Mona Mohamed Alshami ◽  
Mohammad Omar Al-Kaiyat ◽  
Tabrez Pasha ◽  
Nashmia Mutairi ◽  
...  
Keyword(s):  
Cancer Care ◽  
Treatment Plan ◽  
Lessons Learned ◽  
Team Members ◽  
Noticeable Improvement ◽  
Check System ◽  
American Society ◽  
Oncology Practice ◽  
Super Users

263 Background: To assess the quality of cancer care provided at our institution, we participated in Quality Oncology Practice Initiative (QOPI) of American Society of Clinical Oncology (ASCO). However, our initial two rounds revealed lower score than required for QOPI Certification. Our goal was to implement interventions based on lessons learned from the initial rounds. Methods: Prior to the third round and using plan-do-study-act (PDSA) cycles, we identified and worked on three processes: clarifying and enhancing the function of the team, optimizing communication and improving documentation. We created QOPI multi-disciplinary team to include more members from different disciplines. We enhanced the knowledge of the team regarding our electronic health records system (EHRS) by conducting educational sessions and nominating super users who are very competent in EHRS and peer-to-peer support was created. Members were entering data in group sessions with the help of super users. We established double check system for records to be reviewed by two team members before submission. communication was assured among team members through weekly in person meetings and with ASCO QOPI team via virtual meetings to address queries. Documentation was improved by creating newer templates that conform with QOPI requirements including chemotherapy treatment plan, end of treatment summary and documentation of treatment consent. Results: The implementation of these interventions over three PDSA cycles made noticeable improvement in the previously unmet standards resulting in a score that exceeded the benchmark in fall of 2017 (score of 93%). This made our practice eligible for on-site certification visit by ASCO QOPI surveyors on May 2018 to assess practice compliance with QOPI standards. After addressing the unmet standards from the visit, our center became the first QOPI Certified Center in the Middle East and Asia in October/2018. Conclusions: Our journey towards QOPI Certification highlights the importance of fundamental principles in health care: coordinated multidisciplinary team, effective communication and proper documentation that captures essential and critical items reflecting better quality of care.

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

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 222-222
Author(s):  
Rafael Lopez ◽  
Antonio Antón ◽  
Enrique Aranda ◽  
Alfredo Carrato ◽  
Manuel Constenla ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Performance Status ◽  
Well Being ◽  
Pathology Report ◽  
Tobacco Use Cessation ◽  
Counseling And Assessment ◽  
American Society ◽  
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.

Caring for Gravely Ill Children

PEDIATRICS ◽  
1994 ◽  
Vol 94 (4) ◽  
pp. 433-439 ◽  
Author(s):  
Alan R. Fleischman ◽  
Kathleen Nolan ◽  
Nancy N. Dubler ◽  
Michael F. Epstein ◽  
Mary Ann Gerben ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Professionals ◽  
Treatment Plan ◽  
Ethics Committees ◽  
Well Being ◽  
Pediatric Health Care ◽  
Spiritual Well Being ◽  
Primary Focus

Background. Much has been written about the care of the hopelessly ill adult, but there is little guidance for pediatric health care professionals in the management of children who are critically or terminally ill. Methods. Through a 3-day meeting in Tarrytown, NY, attended by a group of pediatricians and others directly involved in these issues, a principled approach was developed for the treatment of, and health care decision-making for, children who are gravely ill. Results. The group agreed that the needs and interests of the child must be the central focus of any treatment plan and that the child should be involved to as great extent possible, consistent with developmental maturity, in the decision-making process. Quality of future life should be viewed as being relevant in all decisions. Parents are believed to be the natural guardians of children and ought to have great latitude in making decisions for them. However, parental discretion is not absolute and professionals must maintain an independent obligation to protect the child's interests. Conclusions. Decision-making should be collaborative among patient, parents, and professionals. When conflict arises, consultation and ethics committees may assist in resolution. When cure or restoration of function is no longer possible, or reasonable, promotion of comfort becomes the primary goal of management. Optimal use of pain medication and compassionate concern for the physical, psychological, and spiritual well-being of the child and family should be the primary focus of the professionals caring for the dying child.

Clinical Oncology Practice 2015: Preparing for the Future

2015 ◽  
pp. e622-e627 ◽  
Author(s):  
Michael P. Kosty ◽  
Anupama Kurup Acheson ◽  
Eric D. Tetzlaff
Keyword(s):  
Clinical Oncology ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Knowledge ◽  
Physician Assistants ◽  
The United States ◽  
Practice Model ◽  
American Society ◽  
Oncology Practice

The clinical practice of oncology has become increasingly complex. An explosion of medical knowledge, increased demands on provider time, and involved patients have changed the way many oncologists practice. What was an acceptable practice model in the past may now be relatively inefficient. This review covers three areas that address these changes. The American Society of Clinical Oncology (ASCO) National Oncology Census defines who the U.S. oncology community is, and their perceptions of how practice patterns may be changing. The National Cancer Institute (NCI)-ASCO Teams in Cancer Care Project explores how best to employ team science to improve the efficiency and quality of cancer care in the United States. Finally, how physician assistants (PAs) and nurse practitioners (NPs) might be best integrated into team-based care in oncology and the barriers to integration are reviewed.

Impact of Health Information Technologies on the Quality of Healthcare Deliveries

2021 ◽  
Vol 6 (1) ◽  
pp. 30-44
Author(s):  
Patricia Whitley ◽  
Hossain Shahriar ◽  
Sweta Sneha
Keyword(s):  
Patient Care ◽  
Health Information ◽  
Medical Errors ◽  
Information Technologies ◽  
Healthcare Delivery ◽  
Well Being ◽  
Quality Of Healthcare ◽  
Quality Healthcare ◽  
The Impact

Through a literary review of recent research, this paper examines the mixed impact of health information technology (HIT) on patient care, medical errors, and the quality of healthcare delivery in selected hospital settings such as emergency departments. Specific technologies examined include the electronic health record (EHR), medical devices, artificial intelligence, and robotics. The paper identifies that some healthcare technologies are increasingly valuable in reducing medical errors, improving healthcare quality, and in producing better patient-centered outcomes. It also determines that technologies have complicated the delivery of quality patient care, increased the incidences of clinician burnout, and made receiving quality healthcare in America's hospital systems possibly less sure. The paper concludes with some suggestions for improving HIT's implementations and confirms the need for further evaluation of the impact of HIT in increasing patient safety and clinician well-being.

An Android-Enabled PHR-based System for the Provision of Homecare Services

2013 ◽  
Vol 3 (2) ◽  
pp. 1-18 ◽  
Author(s):  
Vassiliki Koufi ◽  
Flora Malamateniou ◽  
George Vassilacopoulos
Keyword(s):  
Healthcare Professionals ◽  
Point Of Care ◽  
Treatment Plan ◽  
Personal Health Record ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Appropriate Treatment ◽  
Treatment Plans ◽  
The Continuum

Homecare is an important component of the continuum of care as it provides the potential to improve quality of life and quality of healthcare delivery while containing costs. Personal Health Record (PHR) systems are intended to reach patients outside of care settings and influence their behaviors thus allowing for more effective homecare services. To this end, these systems need to evolve well beyond providing a consolidated patient record, in ways that make it more widely applicable and valuable to health systems. The development of applications on top of PHR systems can allow them to function as a platform for both patients and healthcare professionals to exchange information and interact with the health system. This paper presents a prototype PHR-based system that aims at supporting chronic disease management at any point of care or decision making through familiar environments such as Google’s Android. In particular, it assists healthcare professionals in assessing an individual’s condition and in forming the appropriate treatment plan for him/her while it provides individuals with step-to-step guidance to their treatment plans.

A Process for Measuring the Quality of Cancer Care: The Quality Oncology Practice Initiative

2005 ◽  
Vol 23 (25) ◽  
pp. 6233-6239 ◽  
Author(s):  
Michael N. Neuss ◽  
Christopher E. Desch ◽  
Kristen K. McNiff ◽  
Peter D. Eisenberg ◽  
Dean H. Gesme ◽  
...  
Keyword(s):  
Cancer Care ◽  
Quality Care ◽  
Pathology Report ◽  
Self Assessment ◽  
Colon And Rectal Cancer ◽  
High Concordance ◽  
American Society ◽  
Oncology Practice ◽  
Self Examination

Purpose The Quality Oncology Practice Initiative (QOPI) is a practice-based system of quality self-assessment sponsored by the participants and the American Society of Clinical Oncology (ASCO). The process of quality evaluation, development of the pilot questionnaire, and preliminary results are reported. Methods Physicians from seven oncology groups developed medical record abstraction measures based on practice guidelines and consensus-supported indicators of quality care. Each practice completed two rounds of records review and received practice and aggregate results. Mean frequencies of responses for each indicator were compared among practices. Results Participants universally, if informally, find QOPI helpful, and results show statistically significant variation among practices for several indicators, including assessing pain in patients close to death, documentation of informed consent for chemotherapy, and concordance with granulocytic and erythroid growth factor administration guidelines. Measures with universally high concordance include the use of serotonin antagonist antiemetics according to the ASCO guideline; the presence of a pathology report in the record; the use of chemotherapy flow sheets; and adherence to standard chemotherapy recommendations for patients with certain stages of breast, colon, and rectal cancer. Concordance with quality indicators significantly changed between survey rounds for several measures. Conclusion Pilot results indicate that the QOPI process provides a rapid and objective measurement of practice quality that allows comparisons among practices and over time. It also provides a mechanism for measuring concordance with published guidelines. Most importantly, it provides a tool for practice self-examination that can promote excellence in cancer care.

Driving improvement in oncofertility.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 183-183
Author(s):  
Shelby Darland ◽  
Jennifer N. Eichmeyer ◽  
Kelli Christiaens ◽  
Kallie Penchansky ◽  
Michele Betts ◽  
...  
Keyword(s):  
Support Staff ◽  
Perceived Barriers ◽  
Reproductive Age ◽  
Patient Identification ◽  
Cancer Centers ◽  
Process Implementation ◽  
Chart Audits ◽  
American Society ◽  
Oncology Practice

183 Background: In 2006 the American Society of Clinical Oncology (ASCO) recommended that oncologists discuss infertility as a result of cancer treatment with patients of reproductive age and provide referrals to specialists as needed. Despite these guidelines the majority of cancer centers are not in compliance. Mountain States Tumor Institute (MSTI) piloted a process to improve quality of oncofertility preservation (OP) through identification, documentation, and referral to reproductive specialists. Methods: A physician survey in 2010 indicated that perceived barriers to OP discussion were a lack of accessible materials as well as oversight on the part of the provider. Random chart audits of the Quality Oncology Practice Initiative (QOPI) measures (infertility risks discussed prior to treatment and fertility preservation options discussed/referral to a specialist) occurred biannually at that time. To increase awareness of the data chart audits and reporting shifted to quarterly and included all patients that met OP criteria. Additionally, a committee was formed in 2011 to develop patient/provider packets, collaborate with the local reproductive specialists, and create an OP process. The committee established an OP algorithm involving support staff to flag patients of reproductive age at initial medical oncology consultation and utilizing genetic counselors (GC) and social workers (SW) to expedite and facilitate referrals to reproductive specialists. GC/SW were chosen due to sensitivity with psychosocial issues and to share the additional workload. The OP program was launched in October of 2012. Results: Baseline assessment in 2009 revealed MSTI was compliant 6% and 6%. Six months after program initiation the OP measures improved to 47% and 45% respectively. Notably March and April 2013 showed dramatic improvements with 100% and 75% compliance for both OP measures. Conclusions: It is well known that OP has been a challenge for many cancer centers. This multipronged approach is an example of a novel process implementation that demonstrated significant improvement with the QOPI oncofertility measures. Continued work is needed on improving physician documentation and consistency of OP patient identification.

Assessing and acting on distress in oncology patients.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 89-89
Author(s):  
Jessica A. Zerillo ◽  
Myrna Rita Nahas ◽  
Hester Hill Schnipper ◽  
Laurie Rosenblatt ◽  
Holly Dowling ◽  
...  
Keyword(s):  
Action Plan ◽  
Electronic Record ◽  
Well Being ◽  
Distress Thermometer ◽  
Post Intervention ◽  
Academic Medical ◽  
Distress Score ◽  
Chart Abstraction ◽  
American Society ◽  
Oncology Practice

89 Background: The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) set a benchmark that 75% of cancer patients have emotional well-being assessed by the second visit. However, clinicians poorly assess and document emotional well-being. Methods: Our aim was to increase the documented assessment of emotional well-being in an academic medical center's Hematology/Oncology clinic to 75% or greater through a pre/post intervention study design. In fall 2012, clinicians collected baseline QOPI data from the first two visits of a sample of patients with newly diagnosed breast, non-small cell lung and colorectal cancers. Oncology social work and psychiatry implemented the NCCN Distress Thermometer in May 2013. At every provider visit, patients' distress scores were transcribed into a structured field in the electronic record. In spring 2014, clinicians collected post-intervention data. Results: All data used was collected through the routine QOPI chart abstraction process. 142 charts in fall 2012, and 55 charts in spring 2014 met criteria for pre/post assessment, respectively. There was a significant improvement in the assessment of distress (78.2% vs. 64.1%, p=0.01) and in the identification of distress presence (46.5% vs. 27.5%, p=0.01). However, there was better documentation for a plan of action for distress before the intervention (80% vs. 55%, p=0.02). Conclusions: The NCCN Distress Thermometer improved assessment and identification of distress. However, an action plan specifically addressing distress was significantly worse after implementation of the tool. Possible explanations include lack of documentation even if an action was implemented, lack of specificity of the tool to identify the source of the patient's distress so that a therapeutic plan could be targeted, or a failure of the clinician to appreciate the distress score as a valid measure. Further data are needed in order to understand the barriers for clinician documentation of action on patient distress. [Table: see text]

A Highly-Interactive and User-Friendly PHR Application for the Provision of Homecare Services

2011 ◽  
pp. 197-217 ◽  
Author(s):  
Vasso Koufi ◽  
Flora Malamateniou ◽  
George Vassilacopoulos
Keyword(s):  
Healthcare Professionals ◽  
Service Oriented Architecture ◽  
Treatment Plan ◽  
Personal Health Record ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Technological Infrastructure ◽  
Service Oriented ◽  
User Friendly

Homecare is an important component of the continuum of care as it provides the potential to improve quality of life and quality of healthcare delivery while containing costs. Personal Health Record (PHR) systems constitute a technological infrastructure that can support greater flexibility for healthcare professionals and patients, thus allowing for more effective homecare services. In particular, PHRs are intended to reach patients outside of care settings, influence their behaviors and satisfy their demand for greater information and access. Moreover, PHRs can facilitate access to comprehensive real-time patient data for healthcare professionals thus enabling them to identify problems quickly (e.g. prior to scheduled appointments) and steer patients to appropriate facilities when needed. To this ends, PHR technology needs to evolve well beyond providing a consolidated patient record, in ways that make it more widely applicable and valuable to health systems. The development of applications and tools on top of PHR systems can allow the PHR to function as a platform for both patients and healthcare professionals to exchange information and interact with the health system (e.g., scheduling appointments electronically). This chapter presents a prototype PHR-based system that aims at supporting chronic disease management. In particular, it assists healthcare professionals in assessing an individual’s condition and in forming the appropriate treatment plan for him/her while it provides individuals with a user-friendly application for step-to-step guidance to their treatment plans. The system has been developed on the grounds of a service-oriented architecture where healthcare process automation is realized by means of dynamic, patient-related workflows.

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