Launched in 2002 as a pilot program to promote excellence in oncology care, the origins of ASCO’s Quality Oncology Practice Initiative (QOPI®) date as far back as 1997, when the Institute of Medicine (IOM) created a National Cancer Policy Board to assess the state of cancer care in the United States. The IOM’s findings, published in a report 2 years later,1 concluded that many patients with cancer did not receive high-quality, evidence-based care, although there was not enough information at the time to actually measure quality of care, according to Joseph V. Simone, MD, FASCO, a coeditor of the report.
A pediatric oncologist and active ASCO member, Dr. Simone proposed that ASCO initiate a quality-assessment program with a volunteer group of oncologists to measure the quality of care they provided in their practices and to share the results with their colleagues. The goals of the program, said Dr. Simone, were to promote excellence in oncology care and improve patient outcomes, develop a method to measure progress, reward successful participants, and support ASCO’s mission to ensure access to quality cancer care for all patients.
After the completion of several feasibility studies in 2006, QOPI, a completely voluntary program, was made available to all ASCO members in community and academic practice in the United States, Puerto Rico, and Guam. (Recently, ASCO began test piloting QOPI programs in some European countries as well as Brazil and plans to expand QOPI outside the United States based on level of interest.)
Growth of the Program
Since the launch of QOPI nearly a decade ago, enrollment in the program has grown from 100 to 1,000 oncology practices, and the number of quality metrics developed to assess quality of care has increased from 35 to 180, including more than 40 measures related to pain and symptom management, palliative care, and end-of-life care. Disease-specific modules include breast cancer management, colorectal cancer management, non-Hodgkin lymphoma management, and non–small cell lung cancer management.
In addition to providing individual oncology practices with the tools to improve the quality of patient care and keep current with national practice guidelines, QOPI also contributes to the performance improvement assessment of Continuing Medical Education activities and engagement of fellows in assessment and improvement activities during fellowship training.
In 2010, ASCO launched the QOPI Certification Program (QCP™) to recognize medical oncology and hematology/oncology practices that are committed to delivering the highest quality of cancer care in several areas, including staffing-related standards, treatment planning and chart documentation standards, informed consent, administration, patient monitoring and assessment, chemotherapy-order standards, drug preparation, and patient education. In the future, QOPI reporting will be integrated into CancerLinQ™, ASCO’s health information technology platform, which will be implemented and used by practices starting in 2016.
During a special session at the 2010 ASCO Annual Meeting, Dr. Simone was recognized for the significant contributions he has made to the prevention and management of cancer and for his commitment to quality in oncology with the ASCO/American Cancer Society Award.
The ASCO Post talked with Dr. Simone, President of the Simone Consulting Company, about the effect QOPI is having on the care of patients with cancer.
Origins of QOPI
What was the impetus for your interest in developing QOPI?
The idea was born out of the notion that oncologists had to be involved in changing the culture of medical practice to one in which they could self-check how well they were doing in terms of providing the highest quality of care for their patients and then to measure the care they provided against evidence-based and expert consensus care recommendations.
One of the novel measures we included early on was in pain control. At the minimum, you’ve got to ask patients if they are in pain and, if so, what grade of pain on a scale of 1 to 10. Then you have to show in the patient’s chart that you asked about pain. Getting physicians to do that was difficult.
The bedrock principles that the members of the QOPI steering committee felt were important were that it be a voluntary program, that the data generated would be managed by the participating physicians, that the de-identified data would be collected by the oncology practices and submitted to ASCO for data management, that the results would be returned to the participating practices showing performance compared to other practices, and that ASCO would provide some financial support (with no money accepted from the pharmaceutical industry).
Quality of Care
How is QOPI evolving to address quality-of-care issues?
A study by Arif H. Kamal, MD, [Assistant Professor of Medicine at Duke University School of Medicine] and colleagues investigating quality measures for palliative care found that patient care is often focused on the physical manifestations of disease and the side effects of therapy, with little attention paid to the psychological, social, and spiritual distress of patients.2
In 2014, ASCO teamed up with the American Academy of Hospice and Palliative Care Medicine to establish the Virtual Learning Collaborative (asco.org/vlc), a Web-based technology platform. The goal was to disseminate evidence-based palliative care approaches and provide oncologists with a toolbox of evidence-based resources that would help them put the latest research into practice in such areas as improved symptom management, psychosocial issues, and discussions about goals of care. Practice teams from 26 medical oncology practices participating in the pilot program will report the data on palliative care quality using QOPI measures, and we should have results from the pilot study soon.
ASCO is also developing a QOPI module devoted to palliative care and improving quality of life for patients. The main goal of QOPI is to provide oncology practices with a framework for improving patient care and to make the habit of practice self-examination routine, because that is the only way we become better physicians.
Measuring Results
Are there data to quantify how successful QOPI is in improving patient care?
I was a coauthor of a study published in the Journal of Clinical Oncology in 2013, which analyzed self-reported data from 156 practice groups submitted between 2006 and 2010.3 Our findings showed that there were significant improvements in performance on certain measures for quality oncology care.
Overall, mean normalized performance scores in these practices rose from 71% to 85%, and the practices reported 90% or higher rates of providing adjuvant chemotherapy for breast, colorectal, and non–small cell lung cancers, as recommended. Mean scores of measures related to new clinical practices rose from 5% to 69% overall over 4 years. These new clinical practices included genetic testing for tumor molecular markers that predict response to treatment in patients with metastatic colorectal cancer (eg, KRAS gene alterations before administering anti-EGFR therapy), adequate lymph node examination after surgery in colorectal cancer, and testing for and use of the antinausea drug aprepitant when certain chemotherapy regimens are administered. However, measures that assess smoking cessation and fertility preservation counseling did not improve.
A major weakness of QOPI—and we knew this from its inception—is its inability to tell both oncologists and patients what they really want to know. For example, has QOPI changed patient outcome? Are patients living longer because of improvements in care? We just haven’t gotten there yet, because cancer is so unpredictable.
In the future, there will be new methodologies added to QOPI to improve quality and maximize outcomes and value in oncology practice. For example, ASCO is developing a means of reducing or eliminating manual data abstraction that will allow data to be uploaded from electronic health record–generated reports directly into the QOPI system. In turn, QOPI reporting will be integrated into CancerLinQ, which is scheduled to be implemented and used by practices in 2016. As the genetic component of cancer risk is becoming better understood, ASCO is also developing QOPI measures to assess patient and family cancer risk.
I believe QOPI has contributed positively to the quality of cancer care over the past decade. The program will continue to evolve to provide both community and academic oncologists with the tools they need to have a positive impact on patient outcomes in the future. ■
Editor’s Note: To learn more about participating in QOPI, e-mail qopi@asco.org or visit qopi.asco.org.
Disclosure: Dr. Simone reported no potential conflicts of interest.
References
1. Hewitt M, Simone JV (eds): Ensuring Quality Cancer Care. Washington, DC, National Academies Press, 1999.
2. Kamal AH, Gradison M, Maguire JM, et al: Quality measures for palliative care in patients with cancer: A systematic review. J Oncol Pract 10:281-287, 2014.
3. Neuss MN, Malin JL, Chan S, et al: Measuring the improving quality of outpatient care in medical oncology practices in the United States. J Clin Oncol 31:1471-1477, 2013.
Guest Editor
Education in Oncology focuses on faculty development, medical education curricula, fellowship training, and communication skills. The column is guest edited by Leora Horn, MD, MSc, Associate Professor of Medicine, Assistant Director of the Educator Development Program, and Clinical Director of the Thoracic Oncology Program at Vanderbilt University School of Medicine, Nashville.
