QOPI metrics can be used as a quality incentive for oncologists in a VC plan. Non-oncologists can appreciate the strength of QOPI as a quality tool. The combination of a QOPI program through ASCO and use of various QOPI metrics can drive continuous improvement in an oncology group.
Background:Optimal strategies for quality care of breast cancer survivors include providing value in each visit and appropriately utilizing resources. The purpose of this study was to demonstrate the use of Survivorship Care Plans (SCPs) to coordinate follow-up in a multidisciplinary practice and improve access to breast surgeons. Methods:In 2009, our breast surgeons, medical oncologists and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs which included recommended follow up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines.
162 Background: Use of survivorship care plans (SCPs) was recommended by the IOM in 2005, but benefits are a subject of ongoing debate. ASCO’s Cost of Cancer Care Task Force cited use of unnecessary imaging and tumor markers in breast cancer follow up amongst the “top five” list to improve quality. Communication with breast cancer survivors about guideline based post-treatment follow-up may be improved with SCPs, however few studies have addressed measurable outcomes. We describe use of SCPs to coordinate follow-up care in a multidisciplinary practice. Methods: In 2009, our breast surgeons, medical oncologists, and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. Prior to 2009, follow up was partly determined at physician discretion and partly patient-driven, often with both medical and surgical providers seeing patients within short spans of time. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs, which included recommended follow-up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Results: Implementation of SCPs occurred during 2009; data from time periods two years before and after SCPs is listed below. Wait times were measured from call to first appointment. New patients included both benign and malignant breast disease. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. Patients expressed that uncertainty experienced at the end of active treatment is mitigated by remaining in an environment that can be easily transitioned back to other clinical services. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines. [Table: see text]
241 Background: Physician incentive or variable compensation (VC) models are typically based on work relative value units (wRVU). Baystate Medical Practices (BMP), a group of over 450 practitioners, is evaluating a division based pilot program for VC that, while it includes wRVUs, also includes other important performance metrics. QOPI is emerging nationally as a comprehensive method for assessing quality across oncology practices. We describe the use of QOPI measures as part of a financial incentive plan for a hospital-based oncology division. Methods: A nine member QOPI certified Oncology Division participated in a pilot VC plan with group specific targets selected based on prior below average performance. 20 overall weighting percent (10% weight per category) of the overall VC framework was linked to success in two QOPI categories; “completion of treatment summaries (RxS) within 90 days of end of chemo” and “assessment of patients’ emotional well being by second office visit.” Three tiers of achievement were set for each goal. For RxS completion, Tiers I, II and III were defined as completion of 15, 25, and 40% of charts respectively as measured by an internal audit. For assessment of patient emotional well being tiers were at the 75th, 80th, and 85th percentiles of national QOPI participants. A formula combining VC goals into year-end VC payout was driven by three levels of percent base salary: 8, 12, and 24% respectively. The probability of achievement of each goal was expected to be 90, 50, and 10% respectively. Educational discussions with BMP leadership were held to teach about QOPI validity in the oncology community. Results: BMP fiscal year ends September 30, thus final numbers are pending. With systems based improvements, Tier I achievement for emotional well being and Tier II achievement for RxS completion is expected. The division is interested in using different QOPI measures for VC next year with the goal of continuous improvement in QOPI scores. Conclusions: QOPI metrics can be used as a quality incentive for oncologists in the setting of a VC plan. Non-oncologists can appreciate the strength of QOPI as a quality tool. With time, the combination of a QOPI program through ASCO and use of various QOPI metrics can drive continuous improvement in an oncology group.
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