Joseph V. Simone

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

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.

Improvement in Oncology Practice Performance Through Voluntary Participation in the Quality Oncology Practice Initiative

PURPOSE The Quality Oncology Practice Initiative (QOPI) became available to all American Society of Clinical Oncology member physicians in 2006 as a voluntary medical oncology practice-based quality measurement and improvement project. QOPI assesses practice performance for a series of evidence- and consensus-based process measures, relying on practices to complete structured chart reviews and submit data via a secure Web-based portal. METHODS This analysis focused on the 71 practices that participated in both the March and September 2006 data collections (7,624 charts abstracted in March and 10,240 in September). Among 33 measures common to both collections, five measures were closely correlated, and 28 are included in the final analysis. Composite scores were created for six different domains of care. Statistical significance was tested on both absolute changes and relative changes (relative failure reduction) of quality measures from baseline to follow-up and between the lower quartile and all other quartiles. RESULTS Practice performance on individual measures varied between 18.8% and 98.6%. Mean overall performance as measured by a composite score increased from 78.7% in March to 82.3% in September (P < .05). Improvement was most marked among practices originally performing in the bottom quartile. Using a composite score, the absolute and relative performance for the bottom quartile improved by 27% and 35%, respectively, statistically superior to that of all others. CONCLUSION Practices that participated in QOPI demonstrated improved performance in self-reported process measures, with the greatest improvement demonstrated in initially low-performing practices.

Measuring the Improving Quality of Outpatient Care in Medical Oncology Practices in the United States

PURPOSE The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) has provided a method for measuring process-based practice quality since 2006. We sought to determine whether QOPI scores showed improvement in measured quality over time and, if change was demonstrated, which factors in either the measures or participants were associated with improvement. METHODS The analysis included 156 practice groups from a larger group of 308 that submitted data from 2006 to 2010. One hundred fifty-two otherwise eligible practices were excluded, most commonly for insufficient data submission. A linear regression model that controlled for varied initial performance was used to estimate the effect of participation over time and evaluate participant and measure characteristics of improvement. RESULTS Participants completed a mean of 5.06 (standard deviation, 1.94) rounds of data collection. Adjusted mean quality scores improved from 0.71 (95% CI, 0.42 to 0.91) to 0.85 (95% CI, 0.60 to 0.95). Overall odds ratio of improvement over time was 1.09 (P < .001). The greatest improvement was seen in measures that assessed newly introduced clinical information, in which the mean scores improved from 0.05 (95% CI, 0.01 to 0.17) to 0.69 (95% CI, 0.33 to 0.91; P < .001). Many measures showed no change over time. CONCLUSION Many US oncologists have participated in QOPI over the past 6 years. Participation over time was highly correlated with improvement in measured performance. Greater and faster improvement was seen in measures concerning newly introduced clinical information. Some measures showed no change despite opportunity for improvement.

Milestones in the Curability of Pediatric Cancers

Progress in the study and treatment of childhood cancer is arguably the most remarkable and rewarding story of cancer therapy in the past five decades. During this time, five-year survival rates have steadily increased and now exceed 80% in developed countries for all pediatric cancer sites (Fig 1).1 With the expectation of extended survival into adulthood for most childhood patients with cancer, clinicians and researchers have concentrated considerable attention on optimizing the quality of long-term survival for diseases that largely respond to cytotoxic agents and modalities injurious to normal tissues. In this recollection of that progress, we shall touch on advances common to many childhood cancers but focus primarily on childhood leukemia because it has been the bellwether of scientific and therapeutic advances in many tumors, it encompasses many novel ideas in patient care during and after therapy, and it has influenced the study and treatment of adult cancers as well.

Childhood Cancer Survivorship

This inspiring book becomes one that is very booming. After published, this book can steal the market and book lovers to always run out of this book. And now, we will not let you run out any more to get this book. Why should be childhood cancer survivorship? As a book lover, you must know that enjoying the book to read should be relevant to how you exactly need now. If they are not too much relevance, you can take the way of the inspirations to create for new inspirations.

Development and Future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative

Summary In 1999, the IOM issued a cancer quality report that spurred onQOPI development. In 2013, the IOM released a follow-up report. 29 The update reinforces that there is work yet to be accomplished;however,webelievethatoncologyhasmadesignificantprogresssince1999 and that QOPI has contributed positively. Ongoing evolution oftheQOPIprogram,underthecarefulguidanceofoncologyproviders,is critical to maintaining the relevance and meaningfulness of theprogram to ASCO members and positive impact for their patients. AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Disclosures provided by the authors are available with this article atwww.jco.org. AUTHOR CONTRIBUTIONSAdministrative support: Kristen McNiff, Terry Gilmore, Pamela J.Kadlubek Manuscriptwriting: All authors Finalapprovalofmanuscript: All authors REFERENCES 1. Hewitt M, Simone J: National Cancer Policy Board, Institute of Medicine:Ensuring Quality Cancer Care. Washington, DC, National Academies Press, 1999 2. MalinJL,SchneiderEC,EpsteinAM,etal:ResultsofTheNationalInitiativefor Cancer Care Quality: How can we improve the quality of cancer care in theUnited States? J Clin Oncol 24:626-634, 2006

Evolution and Elements of the Quality Oncology Practice Initiative Measure Set

BACKGROUND Over the past 5 years, the American Society of Clinical Oncology (ASCO) has supported the development of a Web-based quality-reporting tool in response to a recognized need to provide medical oncologists the opportunity to demonstrate the quality of care that they are providing to patients. METHODS The development of quality measures, their basis in the literature, and the descriptions and organizational structure of the measures are discussed. RESULTS Specific results are the property of practices and are not shared outside of the practices except in aggregate. The system allows collection of information concerning a wide range of quality measures in a short period of time. In the last data collection period in the fall of 2008, information was submitted concerning 81 measures of quality divided into one required and six optional modules from over 250 practices concerning 15,000 patients. CONCLUSIONS The timely collection of information on a wide range of quality measures regarding cancer patients can be efficiently collected using a Web-based data collection tool allowing for practice self-examination and comparison with other practices.

A practical program for measuring the quality of ambulatory oncology care in the United States: The Quality Oncology Practice Initiative.

9160 Background: It has become accepted that the keystone to improvement is comparative measurement of patient outcomes and the processes that influence these outcomes. Universal measurement is a goal, though this is possible only with systematic collection of information tied to accepted and explicitly defined data elements and analytic specifications. ASCOs Quality Oncology Practice Initiative allows this to occur on large groups of patients from geographically and structurally diverse practices at an acceptable cost. Methods: Retrospective medical records abstraction conducted at ambulatory hematology-oncology practices across the United States. Abstracted data are submitted twice per year into the QOPI limited data set, using a secure web-based system (JCO Sep 1 2005: 6233-6239). Results: Representative from the spring 2009 data collection period are presented below. In spring, 248 practice sites reviewed 18,131 records providing information concerning 81 measures and in fall, 313 sites reviewed 21,1...