Practice-based improvement (PBI) via web based tool (WBT) in multidisciplinary gynecologic oncology clinic (MGOC)

Abstract

e17545 PBI is a key core competency in fellowship training. Care delivery measurement is increasingly important in medical practice comprising diverse health care professionals. Our MGOC brings together oncology fellows and oncology nurse practitioners (NPs). Long-term survivorship issues like osteoporosis (OP) are important to quality of life. Surgery, chemotherapy or radiation results in early menopause which increase OP risk. Few studies document evaluation of risk of late side effects of cancer therapy. With a retrospective sequential patient (pts) sample, we used American Board of Internal Medicine Practice Improvement Module (ABIM PIM) to assess documented comprehensiveness of OP risk factor evaluation in 25 MGOC pts. ABIM PIM is WBT that enables care process and outcomes assessment in clinical settings compared with national guidelines. Part 1 includes chart abstraction tools, pts, and practice system surveys; part 2 has quality improvement (QI) tools. Part 1 evaluation showed that 68 % pts had endometrial adenocarcinoma; 20% cervical cancer; 12% uterine sarcoma or carcinosarcoma. 76% received whole pelvic radiation; 24% received brachytherapy. Mean age was 63 years (range 41–87). 67% pts had normal bone density scan. Smoking status (100%); exercise levels (84%) were well documented. Exam documented height (84%), weight (96%), height loss (76%); presence or absence of kyphosis (96%) in the majority. 64% of pts had bone density scans. Vitamin(vit) D levels were documented in 4%. No pts had complete fall risk evaluation, estimated dietary calcium (Ca)/vitamin D intake or documented adequacy of Ca or vit D intake. Counseling for appropriate Ca/vitamin D intake was poor (4%/8%). Counseling for weight bearing exercise (WBE) was poor (8%). We have targeted areas for improvement for part 2: vit D level evaluation, assessment of and counseling for adequate of Ca/ vit D intake and WBE. An improvement plan has been implemented. Reassessment of documentation adequacy will be performed on a systematic random sample of 25 pts in 6 months. The ABIM PIM in OP enables fellows and NPs to identify weaknesses in documentation practices and pt care leading to formal QI plans to address long term survivorship issue of OP in MGOC. No significant financial relationships to disclose.