Robert D. Siegel

National Collaborative to Improve Oncology Practice: The National Cancer Institute Community Cancer Centers Program Quality Oncology Practice Initiative Experience

Collaboration between QOPI and the NCCCP sites represents an evolution in the QOPI process, in which QOPI provides a metric for measuring quality and serves as a springboard for comprehensive quality improvement across independent but mutually committed practices.

Quality Improvement in the National Cancer Institute Community Cancer Centers Program: The Quality Oncology Practice Initiative Experience

PURPOSE The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. METHODS A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. RESULTS QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). CONCLUSION Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives.

American Society of Clinical Oncology Quality Care Symposium 2012: Re-Engineering Your Practice to Deliver Quality and Value

This session highlighted the steps in creating a reliable system-based health care delivery system—one that is team based, is continually evolving, and provides the highest quality and efficient care for our patients.

Targeting tumors and financial toxicity in AYAs: Exceptional response to dual immunotherapy in an uninsured young adult with soft tissue sarcoma.

e23530Background: Rising healthcare costs and patient financial toxicities are a pressing issue for the 70,000 AYAs diagnosed annually in the US. To address both of these issues, Bon Secours St. Fr...

Trials and Tribulations for Adolescents and Young Adults with Cancer: Measuring the Impact of a Community-Based Program

Howland E. (Hal) Crosswell, MD, serves as Director of the Adolescent and Young Adult Hematology/Oncology Program and maintains a clinical practice at Bon Secours St. Francis Cancer Center in Greenville, South Carolina. He is double board certified in pediatrics and pediatric hematology/oncology. He is Chair of the AYA Committee of the Southeastern Community Oncology Research Consortium and is a member of the NCTN and NCORP AYA Working Groups. Dr. Crosswell is an affiliate member of the Hollings Cancer Center at The Medical University of South Carolina (MUSC) in Charleston, South Carolina. He also serves as Chief Medical Officer of KIYATEC, Inc., a Greenville-based life sciences company specializing in ex vivo 3D cell culture and tissue systems that more accurately replicate human biology and function. Dr. Crosswell is principal investigator for KIYATEC’s NIH-funded research projects, including 2 NCI contracts focused on modelling breast, brain, and lung cancer, and developing a laboratory-based method for making clinical-grade platelets. Trials and Tribulations for Adolescents and Young Adults with Cancer: Measuring the Impact of a Community-Based Program

Palliative care in the ambulatory setting: Bon Secours St. Francis Hospital (BSSFH).

109Background: Palliative care is integral to holistic cancer therapy. Early integration of palliative principles results in improvements in quality of life and survival. Despite the evident value of specialized palliative services, the conventional delivery paradigm, particularly in community centers, has remained episodic, crisis driven, and principally provided in the acute care setting. BSSFH opened its cancer center in October 2014. We chose to embed palliative services in the ambulatory setting to introduce patients early in their cancer journey to an integrated program of symptom management. Methods: The BSSFH Cancer Center is a 65,000 sq ft facility located in Greenville, SC. The analytic caseload for 2016 was approximately 1250. One palliative care practitioner per day sees patients both independently and concurrently with medical, gynecological and radiation oncology colleagues. These individuals also participate in Lean projects optimizing care in a variety of disease states. Mandatory referral...

ASCO Quality Care Symposium 2016 Exemplars in Quality and Identifying High-Quality Practice: Delivering Quality in the Community Setting (Bon Secours St Francis Cancer Center)

On the basis of data from the American Cancer Society and the National Cancer Institute, greater than 85% of cancer patients are treated in community cancer centers (CCCs) within the United States. Although there have been avenues for community participation in therapeutic research for decades, the opportunities for contributing to the quality discussion have beenmore restricted. The small size of many community cancer programs and the lack of staff skilled in quality improvement (QI) methodology have limited substantive participation of CCCs in the QI discourse. In addition, there are unique features of CCCs that make the deployment of QI across the spectrum of organizations potentially problematic. These programs constitute a heterogeneous assortment of relationships between hospital and physician practice, including hospital-employed models, private practice, as well as free standing and hospitalaffiliated centers. Nevertheless, despite the potential difficulties associated with developing a standardized QI process for CCCs, there can be no movement toward the triple-aim goals of improved individual and population health care and reduced overall cost without substantive community participation, given the sizable role these organizations play in the provision of cancer care. At the 2016 ASCO Quality Care Symposium (QCS), the Bon Secours Saint Francis Cancer Center (BSSFCC) was honored with the opportunity to present our QI efforts as an exemplar from the community. Much of what I present in this article cannot be elevated to the level of conventionally “scientific” in that there are no clear end points, no inclusion/exclusion criteria, andno consensus-based assessment tools that unequivocally measure the effect of interventions. We have neither the size nor expertise to provide such data. Nevertheless, we at BSSFCCbelieve that CCCs can andshouldbe incubatorsofQI interventions despite these shortcomings. In many ways, the size of programs such as ours maymake us optimal sites to test novel concepts that might resonate with other organizations. Upon arriving at this year’s QCS, I noticed what was an apparent metaphor for this conundrum.Therewas a sign at the breakfast buffet that stated “Bran Muffins, made with gluten, prepared in a nut-free environment.” It was an inexpensive sign, yet it undoubtedly avoided harm to those who might have experienced significant morbidity from the ingestion of the muffins. I haveno ideahowmanypeople, if any,

Improving quality of care within the NCI Community Cancer Centers Program (NCCCP) network.

178 Background: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) was initiated to expand cancer research and deliver quality cancer care in communities. A program goal was support of quality care initiatives. Twenty-one community sites in 16 states participated in the network providing care to approximately 40,000 cancer patients/year. We describe strategies for implementation of a structured quality program within our network. METHODS Four components served as the foundation for quality efforts: 1) increasing multidisciplinary care (MDC) programs; 2) ASCO QOPI participation; 3) Commission on Cancer Rapid Quality Reporting System (RQRS) participation; and 4) expansion of genetic counseling/services. A Quality of Care subcommittee formed to guide quality efforts within the network. Clinicians from the network served as subcommittee leadership and each site designated a quality of care lead. The subcommittee met by teleconference monthly, developed goals, shared best practices, developed processes to accomplish goals and documented improvements in priority areas. RESULTS Strategies employed to improve quality included: assessment tool development, participation in national quality reporting initiatives, review and monitoring of network data, and network performance improvement projects. CONCLUSIONS The NCCCP identified areas of needed quality improvement. In addition, the network developed implementation strategies and created benchmarks that measure program quality. Participants benefitted from the opportunity to interface with one another and set network goals, while adopting strategies to best fit their own practices and community sites. [Table: see text].

Utilizing QOPI in the quality improvement efforts of the NCI Community Cancer Centers Program (NCCCP).

208 Background: The NCCCP is a network of community based institutions from New England to Hawaii funded by the NCI. Quality of care is a priority of the NCCCP with participation in ASCOs Quality Oncology Practice Initiative (QOPI) playing a fundamental role. QOPI provides a process for quality assessment but we have also used it as a measure of quality improvement (QI) network-wide. Using QOPI methodology, we have analyzed our performance twice a year in an effort to enhance our implementation of quality indicators relevant to program aims. METHODS A data sharing agreement allows individual practice QOPI data to be electronically sent to the NCI where it is aggregated with the other NCCCP QOPI participants. Data are presented via webinar within the network using a variety of QI strategies. For example, blinded site performance distributions are benchmarked against NCCCP national averages on specific indicators. High performing practices voluntarily present their QI initiatives and best practices to the network. The NCCCP Quality of Care Subcommittee then selects QI projects and areas to focus quality improvement efforts. RESULTS In Spring 2012, 44 practices affiliated with 25 NCCCP sites participated in QOPI, a consistent pattern since Fall 2010. The table below describes the percent compliance with certain QOPI measures for the NCCCP aggregate over time. Selected measures were perceived as having had suboptimal compliance in Fall 2010. CONCLUSIONS QOPI is an effective tool for assessing quality within a network and for measuring quality improvement efforts. Best practices from within the network can be leveraged and disseminated to enhance the quality of cancer care. This methodology facilitates quality initiatives despite the logistical challenges of working with practices across the country. [Table: see text].

Developing the RECIST Criteria Toolkit NCCCP Sites Use This Tool to Improve Compliance

Oncology Issues March/April 2011 n 2009 the NCCCP Best Practices Working Group of the Clinical Trials Subcommittee was tasked with developing a RECIST (Response Evaluation Criteria in Solid Tumors) criteria toolkit. RECIST is a set of criteria defined by an international committee to measure tumor response via CT, MRI, and X-ray using formalized rules for measurement of tumor target lesions. While compliance with RECIST criteria in itself does not increase accrual to multi-modality clinical trials, the use of standard techniques and tools to measure response to treatment on imaging lends greater power and credibility to the results obtained, especially in multi-modality treatment plans. One of the goals of the Clinical Trials Subcommittee was to enhance NCCCP site compliance with use of the RECIST criteria in the evaluation of imaging studies used to measure response to treatment of solid tumors. As part of this effort, educational materials and tools were provided to physicians and clinical trial professionals within the network. The resources were designed to simplify the process of measuring and comparing time imaged malignant lesions across studies. NCCCP sites were able to use the tools for education, adoption, and/or implementation as they deemed appropriate.