A nascent quality improvement program launched by the American Society of Clinical Oncology (ASCO) has taken root in fellowship programs around the country, giving trainees experience with one of the defining aspects of modern medicine: self-reflective practice improvement.

Launched nationally in 2006, the Quality Oncology Practice Initiative (QOPI) was initially adopted by more than 130 oncology practices and 8 fellowship programs within the first year. As of March 2011, more than 690 practices were participating in the program.1

Of the approximately 150 fellowship programs in the United States, 42 are currently registered in QOPI and roughly 10 to15 of these programs participate in each round of reporting, according to Allen S. Lichter, MD, CEO of ASCO.

Essentially, the volunteer program assesses performance using a series of evidence- and consensus-based process measures, which practices report based on chart reviews and submit via a Web-based portal.2

Those involved with developing and launching the program say that it provides both short- and long-term benefits for trainees; not only does it provide fellows with a self-reflective experience that directly improves their patient care, but it also familiarizes them with measuring their quality, which is quickly becoming an everyday part of the practice of medicine.

“The value of exposing fellows to measuring performance can’t be overestimated,” said Joseph Jacobson, MD, chief quality officer at Dana-Farber Cancer Institute in Boston, and one of the founding members of the QOPI program. “Getting fellows to take a step back and not just look at the patient who is right in front of them but rather to survey their practice and see what patterns emerge, what their strengths are, and what their opportunities [to improve] are–—that’s the huge value.”

Broadly speaking, the program currently includes about 100 process measures across 4 diseases—breast cancer, colorectal cancer, non-Hodgkin’s lymphoma, and non-small cell lung cancer—with the goal to continuously add relevant measures and new disease modules in the future. However, the program also is expanding in a number of other, more far-reaching ways.

Process measures, as opposed to outcome measures, were chosen because they offer practices and fellowship programs an opportunity to immediately gain a sense of their performance. In fellowship programs, trainees most often review and abstract data from their own patients or from disease modules that reflect the type of patients they are seeing. Once the measures are reported, the performance data can be parsed a number of ways; however, for the most part fellowship programs use them on a program-wide basis, rather than to judge an individual’s performance. For example, at Vanderbilt University in Nashville, Tennessee, fellowship directors identify a “seemingly very benign” area where performance is likely less than ideal and then implement a plan to formally improve. The data are then rechecked in 6 to 12 months to gauge any improvement.

“Participating in the program is just the reality of where we are going as full-fledged medical practitioners in general. It’s about learning good habits and getting used to doing this kind of practice- and quality-improvement project early in your career because it is just part and parcel of what we do now, period,” said Jill Gilbert, MD, associate professor of medicine and director of the Hematology/Oncology Fellowship Program at Vanderbilt.

Early studies are showing that gains are typically significant. Fellows from the University of Kansas Medical Center presented their 2-year experience with QOPI at the 2011 ASCO annual meeting. They characterized their QOPI experience as “rapid” and “substantial” in many of the processes measured. Of a small sample of measures they reported, compliance improved by 50% to 90%.3

Other studies have shown that although chart abstraction takes about 10 hours of fellows’ time, the fellows appreciate the experience and often interact more with the tumor registry, faculty, and nursing staff at their institutions as a result, leading to changes in practice.4

Ultimately, however, Dr. Jacobson said the program needs to advance from showing increased performance in processes of care to actually demonstrating an improvement in outcomes. That is the direction QOPI must now move toward, he said.

The program also has longer-term benefits for fellows themselves, beyond improvements in their patient care.

QOPI was designed to meet the American Board of Internal Medicine’s (ABIM) Performance Improvement Module (PIM) requirement for Maintenance of Certification.

“Every 5 years the ABIM medical oncology boards require a quality improvement or practice improvement activity, and people in fellowship who have learned to do it then can do it more easily in their recertification effort,” says Michael Neuss, MD, chief medical officer at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, and a founding member of QOPI.

Separately, QOPI also provides its own 3-year certification for outpatient hematology-oncology practices that meet a threshold for reporting their performance and then complying with standards of care.

The program’s leadership currently is looking for fellows who might wish to play an active role in developing the program, said Dr. Jacobson. One possible role could be in the form of a rotating position for a fellow on the QOPI Steering Committee. He also described the possibility of creating a fellowship-based “collaborative improvement network,” in which fellows at different programs discuss ways to improve compliance with particular measures and exchange effective approaches.

Fellows interested in volunteering or learning more about the program can find information at qopi.asco.org or by contacting qopi@asco.org.

References

     
  1. American Society of Clinical Oncology. The Quality Oncology Practice Initiative: Program Overview. Retrieved from http://qopi.asco.org/Documents/QOPIProgramOverview3-17-11.pdf. Accessed October 21, 2011.
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  3. Jacobson JO, Neuss MN, McNiff KK, et al. Improvement in oncology practice performance through voluntary participation in the Quality Oncology Practice Initiative (QOPI). J Clin Oncol. 2007;25(18S):6505.
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  5. Amin MA, Hashmi MH, Taylor SA. Rapid improvement in evidence-based, quality care of cancer patients with initiation of ASCO’s Quality Oncology Practice Initiative (QOPI). J Clin Oncol. 2011;29(suppl; abstr 6134).
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  7. Warren RC, Tevaarwerk AJ, Attia S, Grade D, Stewartet JA. ASCO Quality Oncology Practice Initiative (QOPI): Lessons in clinical quality improvement (QI) for hematology/oncology fellows. J Clin Oncol. 2008;26:(suppl; abstr 6609).
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