The Lynx Group

Quality Oncology Practice Initiative Shows Strong Improvement in Some Care Measures

January 2013, Vol 4, No 1

San Diego, CA—Adherence to several quality care standards markedly improved in practices participating in ASCO’s Quality Oncology Practice Initiative (QOPI) over a 4-year period, according to a study presented at ASCO’s inaugural 2012 Quality Care Symposium.

QOPI Participation Enhances Performance

The findings indicate that the oncology practices that participate in the QOPI are able to document significant and rapid improvement in their overall performance. Approximately 15% of US oncology practices are now participating in the QOPI.

“Medical oncology practices have improved in some, but not all, measures of care. The greatest improvement was seen in measures assessing the adoption of new clinical practices,” said lead author Michael N. Neuss, MD, Chief Medical Officer at the Vanderbilt-Ingram Cancer Center in Nashville, TN.

The 308 oncology practices currently participating in the QOPI program report data twice annually on approximately 50 measures. Of these, 156 were included in this analysis; 152 were excluded for various reasons.

A database of these reports was used to evaluate trends in scoring among participants from 2006 through 2010. A linear regression model, which controlled for variability in baseline performance among practices, was used to estimate the effect of participation over time. Measures were aggregated into categories to evaluate which factors correlated with positive changes.

Participants completed a mean of 5.7 rounds of data collection. Measures showing improvement included ap­­propriate KRAS testing in patients with colon cancer, the appropriate use of agents targeting the epidermal growth factor receptor, the investigation of 12 or more lymph nodes after colon cancer resection, and the appropriate use of aprepitant for chemotherapy-induced nausea and vomiting. For example, adherence to KRAS testing guidelines improved from 70% at baseline to 85%, and the examination of 12 or more nodes was documented by 60% at baseline, improving to 100% at the final data collection round.

Rapid Adoption of New Treatments

“We saw rapid improvement in some areas, including the adoption of new treatment modalities, and we have done very well also in adherence to recommendations for adjuvant chemotherapy in breast, colorectal, and non–small-cell lung cancers; however, all 3 of these tumor areas showed a very high level of baseline performance level, which made it harder to show improvement,” Dr Neuss pointed out.

For example, the appropriate documentation of guideline-concordant recommendations for adjuvant chemotherapy in breast cancer was almost 95% at baseline; this rose to approximately 98% at the final analysis. “On many adjuvant treatment measures, it appears that QOPI participants are already doing very well,” he observed.

“Although improvement was rap­id for many measures, there was no improvement seen for others,” Dr Neuss said. “Several measures were resistant to change despite a gap.”

Although smoking status was adequately documented (90% at baseline, rising to approximately 95%), smoking cessation interventions were not well adopted. The interventions were reported by approximately 18% of practices at baseline, and were stabilized at approximately 35% by the study’s end.

“Similarly there is good reason to discuss the risk of infertility and the potential for fertility preservation in certain chemotherapy patients, but this was done in fewer than 15% of cases,” he noted.

The researchers evaluated the ef­­fect of instituting the QOPI measures over time on the mean quality scores. The adjusted mean quality scores improved from 0.71 to 0.85, for an overall odds ratio of improvement over time of 1.09 (P <.001). The greatest improvement was seen in measures assessing newly introduced clinical information, where the mean scores improved from 0.05 to 0.69 (P ≤.001), Dr Neuss reported.

He said that the analysis provides “reassuring evidence that the level of care received in oncology practices that participate in QOPI is very high, and that new treatments are rapidly incorporated into practice.”

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