Michigan Oncology Practices Showed Varying Adherence Rates To Practice Guidelines, But Quality Interventions Improved Care

Abstract

Despite improvements in care for patients with cancer, and in their survival rates, it is not clear that best practices are uniformly delivered to patients. We measured the quality of outpatient cancer care, using validated quality measures, in a consortium of thirty-six outpatient oncology practices in Michigan. We discovered that throughout the measurement period, for breast and colorectal cancer care, there was a more than 85 percent rate of adherence to quality care processes. For end-of-life care processes, the adherence rate was 73 percent, and for symptom and toxicity management care processes, adherence was 56 percent. In particular, we found variations in care around the fundamental oncologic task of management of cancer pain. To address quality gaps, we developed interventions to improve adherence to treatment guidelines, improve pain management, and incorporate palliative care into oncology practice. We concluded that statewide consortia that assume much of the cost burden of quality improvement activities can bring together oncology providers and payers to measure quality and design interventions to improve care.

Improving care with portfolio of physician-led cancer quality measures at an academic center.

“…Measurement of quality performance, including implementation of the QOPI measurement tool within an academic medical center, 9 in a statewide network sponsored by a regional payer, 10 in a state-wide affiliation of practices centered on an academic medical center, 11 and in a governmentsponsored affiliation of oncology practices, 12 has been accomplished. Retrospective analysis of quality of care measures within a system, such as at the Veterans Health Administration, 13,14 is also possible.…”

Administration of Oral Chemotherapy: Results From Three Rounds of the Quality Oncology Practice Initiative

“…Clinicians' medical record documentation and practices' self-reporting of manual chart abstractions are both prone to error and bias and may lead to over-or under-reporting. 33,34 However, given that the oral chemotherapy test measures were voluntary and were not part of the QOPI certification process, and that there were not QOPI incentives for high achievers, the results may have been less prone to bias compared with other QOPI measures.…”

Novel Data Sharing Between a Comprehensive Cancer Center and a Private Payer to Better Understand Care at the End of Life

“…29 Additional claims-based studies have been conducted outside of the U.S. 4,30e33 Using modified measures based on individual institutional medical records abstraction, the American Society of Clinical Oncology's Quality Oncology Practice Initiative has found national variation and performance gaps within the U.S., with some evidence that assessment over time is associated with improvement. 34,35 Our project sought to apply these measures to patients with private insurance, which has received less attention to date. Our institution, the Dana-Farber Cancer Institute (DFCI), collaborated with Blue Cross Blue Shield of Massachusetts (BCBSMA), which insures approximately 25% of patients at DFCI.…”