It has been more than 10 years since the creation of the ASCO Quality Oncology Practice Initiative (QOPI®), an oncologist-led, practice-based quality assessment and improvement program. However, the oncology community is still trying to develop, perfect, and facilitate the widespread use of quality measures in cancer care.
“It is really critical that the clinical oncology community is part of the quality discussion and how it is measured,” said Helen Burstin, MD, MPH, FACP, chief scientific officer of the National Quality Forum. “It is important to build a measurement approach that includes the perspective of front-line clinicians and patients in terms of what is working and what is not.”
Dr. Burstin and colleagues will address the current landscape of quality measurement in oncology Monday, June 1, during the Education Session entitled, “Quality Measurement in Health Care: Tools to Improve Care,” from 8:00 AM-9:15 AM, in room S100a.
A Shift Toward Quality
From a common-sense perspective, it would seem as though quality were always an important aspect of health care. But the scientific measurement of quality has not always been a part of the environment, Dr. Burstin said.
A shift toward the idea of quality in medicine began about 15 years ago with the release of two Institute of Medicine (IOM) reports addressing quality in health care: To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001).1,2
To Err is Human discussed the prevalence of preventable medical errors occurring in the health care system and the cost of these errors “in terms of loss of trust in the health care system by patients and diminished satisfaction by both patients and health professionals.”
Crossing the Quality Chasm discussed strategies to close the gap between the health care system as it stood and its potential. A new quality-based system would aim for safe, effective, patient-centered, timely, efficient, and equitable care.
“We made an assumption that we were doing a great job without any data to support that assumption,” said
Lawrence N. Shulman, MD, chief of staff at the Dana-Farber Cancer Institute. “That was the spirit of American medicine: if we tried hard and did the best we could, that was terrific.”
These two IOM reports prompted the health care industry to look more critically at itself, said Dr. Shulman, who is also a presenter during the Education Session. People started realizing that results were not always what they should have been.
“Cancer medicine has high stakes. Many cancers we treat are potentially curable, and if the care is not high-quality treatment, a patient’s chance for cure is diminished,” Dr. Shulman said. “In addition, cancer treatment is inherently toxic, and only by measuring the quality of care can we assure the best outcomes for our patients, while minimizing treatment associated morbidity and mortality.”
ASCO created QOPI in 2002 in response to the call for better quality in health care. QOPI was designed to promote excellence in cancer care by helping oncology practices self-assess their treatment for the purpose of improvement.
“QOPI involves oncology practices manually abstracting a small sampling of cases, measuring themselves against certain quality measures, and comparing their performance with that of other practices that have participated in QOPI,” Dr. Shulman said.
More recently, ASCO began the development of CancerLinQ™, a health information technology platform that will provide oncologists with real-time feedback on quality.
CancerLinQ will give personalized guidance to physicians to help them choose the right therapy at the right time for each patient based on clinical guidelines and experiences of similar patients.
Another approach to quality measurement is the National Cancer Data Base (NCDB), which is sourced from hospital registry data collected from more than 1,500 Commission on Cancer–accredited facilities. The NCDB can provide institutions with comparative benchmark reports and tools to help improve delivery and quality of care provided.
“These are tools with different approaches, but the conclusion for all is that the beginning of any quality work starts with measurement,” Dr. Shulman said. “Unless you can measure how you are doing, there is no way of knowing where there are gaps in patient care and what interventions can be designed to improve that care.”
During the Education Session, Dr. Burstin will present information about how to evaluate quality in health care. She will be joined by Craig Earle, MD, director of Health Services Research at the Ontario Institute for Cancer Research, and Dr. Shulman. Together, they will discuss the current quality measure landscape in oncology and how these quality measures are being used in everyday oncology practices.
Quality in health care is best viewed in three categories, Dr. Shulman said. First is patient safety, or ensuring that treatment gets delivered to the patient in the manner intended. For example, were the dosing and schedule correct? Second, process quality is measured. Did the patient receive the ideal treatment for their type of cancer and their stage of disease? Third is measuring outcome. Did the patient survive for the amount of time expected, compared with known survival rates? Was their quality of life as good as it should be based on the given treatment?
The Education Session will also include a discussion of the framework for identifying, developing, and defining quality measures. Dr. Earle will discuss different types of quality measures, such as those that measure structure, process, or outcome, and he will review of some of the most common quality measures used in oncology practice.
“Everyone is becoming more and more exposed to the idea of quality measurement,” Dr. Earle said. “The more people are able to understand where these measures come from and their strengths and limitations, the better we will be able to use quality measurement appropriately to improve the care of our patients.”