By Amye J. Tevaarwerk, MD
Medical Oncology Fellow
University of Wisconsin
Paul P. Carbone Comprehensive Cancer Center
In 2006, ASCO invited several oncology fellowships to participate in the Quality Oncology Practice Initiative (QOPI
TM) as a pilot project and to describe their experience and the role the program could play in fellowship activities. Our program at the University of Wisconsin participated in this initiative in the spring of 2006 and the fall of 2007. I framed the following description as a mock interview, using questions most fellows would ask before adding any project to their hectic schedules.
What is QOPITM? QOPI
TM is a self-assessment tool developed by and for oncologists. It measures indicators of quality care that are within the control of a medical oncologist. The program’s modules cover a range of issues from across the oncology spectrum, such as “End-of-life Care” or “Colorectal Cancer.” Each module includes a set of disease- or domain-specific questions.
Why participate? Our Program Director challenged us to prove that University of Wisconsin (UW) oncology fellows provide high quality care. Our instinctive response was “Of course we do!” Prior to QOPI
TM, we could offer only anecdotal evidence. This tool allows us to support that claim with data.
What did you do? We selected three modules per year for review. Clinic charts were chosen randomly, but had to meet several QOPI
TM program criteria: an invasive cancer diagnosis for the patient within two years and a clinic visit with a fellow within six months. Fellows reviewed each chart and extracted the data to answer QOPI
TM questions. Eight fellows reviewed an average of 12 charts each. Fellows were not allowed to “interpret” an answer from the chart: rather, they recorded chart information only as it was documented.
QOPI
TM analyzed and tabulated the results, and created our fellowship practice panel (FPP). Our data were compared to a group practice panel (GPP) of aggregate data from 13,450 charts. Fellows then formed teams; each team reviewed the results for a single module and compared our results to the GPP. Our FPP scored better than or within 5% of the GPP over 75% of the time. We investigated our worst scores and developed quality improvement (QI) plans to correct these deficits.
How long did it take? What did you learn? What could be improved? We each spent five to seven hours on chart review alone and another five hours or so reviewing our results, formulating a QI plan, and presenting it to faculty.
QOPI
TM allowed us to critically review our practice. Some shortcomings were individual failures to fully document (not dictating the planned numbers of chemotherapy cycles). Other problems were system-based; for example, our clinic does not systematically track patient deaths, which rendered the End-of-life module difficult. Many problems could be remedied with an electronic health record (EHR) utilizing automatic prompts; QOPI
TM places a heavy emphasis on documentation. Some oncologists will argue that great notes do not necessarily equal a great doctor. However, good documentation is the simplest way to “prove” the quality of care objectively.
QOPI
TM could be refined to better meet the needs of academic centers. We wrestled with the inflexibility of some answers (e.g., no multiple choice options for outside consults). We disagreed on the utility of some quality measures proposed by QOPI
TM, such as the number of lymph nodes sampled at colectomy. Is this really under the medical oncologist’s control?
The process generated heated discussions regarding the definition of “quality care” in oncology. Quality care in oncology has been difficult to define, partly because of its multidisciplinary nature; this fact makes QI plans hard to develop but all the more important to test. QOPI
TM also should include a forum for feedback so that users can discuss ambiguous questions and suggest standards for coding the charts.
How do I get the most out of QOPITM? Chart review can be tedious. However, abstracting the charts gave us significant insight into the strengths and weakness of QOPI
TM data and made it harder to refute results. If possible, abstract a few charts yourself. QOPI
TM could help providers modify their performance, too. Select a few charts of your own to mock-review; it’s illuminating! Use the results to improve your EHR template. Also, consider a QOPI
TM “party.” Meeting as a group to review charts promotes consistency and allows everyone the chance to agree on the “rules of interpretation.”
Would you do it again? The medical world increasingly emphasizes not just practicing quality patient care, but proving the quality of that care through external standards. QOPI
TM is a current tool that can be adapted for use in fellowship settings. It could also be used for intra-fellowship comparison.
How do I sign-up? Visit
www.asco.org/qopi. If you have questions regarding the program, please send an e-mail to
qopi@asco.org.
Promising Cancer Researchers Receive Grants from The ASCO Cancer Foundation
The ASCO Cancer Foundation supports educational programs of the highest quality in cancer care and ensures capable leadership and scientific investigation for the oncology community of tomorrow through its prestigious grants program. In 2008, the ASCO Grants Selection Committee recognized the early clinical work of 56 oncologists through the presentation of 43 Young Investigator Awards (YIAs) and 13 Career Development Awards (CDAs). (
See a list of 2008 YIA and CDA winners.)
This year, The ASCO Cancer Foundation is celebrating 25 years of supporting oncology’s best and brightest through grants and awards for promising research that advances the field of cancer care. Since the inception of the grants program in 1983, the Society has awarded more than $50 million in support of clinical investigations conducted by deserving researchers. The growth of the program is made possible by the continued generous support of the pharmaceutical industry and private foundations.
For more information about The ASCO Cancer Foundation Grants Program, visit The Foundation’s website,
www.ascocancerfoundation.org, or the “Foundation Grants and Awards” section of ASCO.org. Prospective applicants also can submit queries by sending an e-mail to
grants@asco.org.
