Serial measurements of quality measures using the quality oncology practice initiative (QOPI) by oncology trainees (fellows) at a single institution
Authors: A. M. Schreiber, M. Jahanzeb, L. Kronish
Journal: Journal of Clinical Oncology (2008)

17516 Background: QOPI was designed to develop and validate quality measures as well as a process for data collection, reporting, and sharing of innovations. QOPI was started at selected institutions last year including UTCI. Methods: Nine fellows at UTCI participated in the ASCO QOPI project in April 2007, and ten in October 2007. Data was obtained through a chart review. The measures were broken down into specific core measures common across cancers (including smoking) domain specific modules (such as antiemetics) and disease specific modules (breast, etc.). A total of 57 measures were evaluated (14 in the core modules, 17 in the domain specific modules, and 26 in the disease specific modules). Each data point was evaluated with a yes (positive)/no (negative) or numerical response. A total of 48 charts were reviewed in April and 73 in October by the fellows. The percentage of positive responses was obtained and compaired for each of the 14 core measures in both April and October. Results: Each of the 14 core measures was tested for an association between a patient's response (positive/negative) and time period (spring/fall). Fisher's Exact test was used. Ten of the 14 core measures reviewed showed an increase in the level of compliance with ASCO standards. The remaining four measures showed a decrease in compliance. Four of the measures were statistically significant at the .05 level, three for an increase in compliance with ASCO standards including chemotherapy intent documented, treatment discussion and patient consent documented, and cigarette smoking status documented by the second office visit. The flowsheet compliance may have dropped due to its migration to our electronic medical record and not picked up on this review of paper charts. Conclusion: QOPI measurements at a six month interval appear to show improved adherence to the standard of care in oncology. Whether this is due to QOPI, additional training, or both cannot be ascertained from the present data. QOPI Core Measures Spring 2007 Fall 2007 Results N = 48 N = 73 p < 0.05 Pathology report confirming malignancy available in the chart 42/48 68/73 0.34 87.5% 93.2% Explicit statement of staging within one month of first office visit 42/44 59/67 0.31 95.5% 88.1% Pain addressed in first office visit 32/48 57/73 0.211 66.7% 78.1% Effectiveness of pain medicine accessed after narcotic prescription 1/2 3/5 1.00 50% 60% Documented plan for chemotherapy before started (including dose/time interval) 32/33 46/47 1.00 97% 97.9% Chemotherapy intent (palliative vs. curative) documented 25/33 44/47 0.0439 75.8% 3.6% Chemotherapy intent discussion with patient documented 19/25 42/47 0.17 76% 95.5% Number of chemotherapy cycles documented prior to administration 19/19 23/28 0.0717 100% 82% Signed patient consent for chemotherapy in chart 29/33 41/47 1.00 87.9% 87.2% Treatment discussion & patient consent for administration of chemo documented 19/33 44/47 0.0002 51.6% 93.6% Some form of patient consent documented 30/33 47/47 0.0664 92% 100% Flowsheet for chemo with doses, dates of administration, blood counts in chart 33/33 8/12 0.0033 100% 66.7% Cigarette smoking status documented by second visit to office 10/19 57/72 0.0372 52.6% 79.2% Smoking cessation counseling provided to smokers by second visit to office 0/3 6/22 0.56 0% 27.3% No significant financial relationships to disclose.