The American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI®) is a voluntary program designed to assess and improve processes of care in oncology practices. QOPI measures are evidenced-based and consensus-based measures that are derived from published research studies, peer-reviewed guidelines, and expert consensus. The mission of QOPI is to provide a means by which oncology practices can continually examine the care they provide, to ensure that each patient receives the best care possible. The framework of QOPI promotes a system that is:
• Designed and run by oncology practitioners.
• Relevant and valuable to all oncology practices.
• Deliverable anywhere.
• Capable of measuring progress with peer comparison.
• Simple and inexpensive to implement and use.
• Dynamic and modifiable and current.
• Focused on improvement, not research.
QOPI began as a pilot program in 2002, with 23 practices abstracting 6,000 charts over 4 years to collect data on 37 measures. In 2006, the program was made available at no charge to ASCO members in the United States; however, practices bear the cost of data collection and submission—that is, the practices collect and submit data to an ASCO system, and ASCO provides support through data collection and analysis. Over time, the number of QOPI measures has increased, and they are now arranged into modules of required core measures; disease-specific groupings for specific types of cancer; and other groupings that include symptom/toxicity management, and end-of-life care. In 2008, 193 practices abstracted more than 18,000 charts to collect data on 81 measures. QOPI registration had grown to more than 700 practices by 2010, with practices located in all 50 states, Puerto Rico, and Guam. More than a quarter of registered practices (260) submitted data on 26,651 patients in the fall 2010 data collection period.
How QOPI Works
ASCO provides training and a manual to guide practice staff in conducting retrospective chart reviews up to twice per year. In the fall 2010 data collection period, a limited dataset for 107 QOPI measures was available for abstraction and entry into QOPI's secure Web-based application. At the close of data collection, practice reports are provided that compare practice-specific results to aggregate data of the entire set of results and also with data from similar-type practices (eg, academic or independent/private). Reports are available within one month of the close of the data submission period.
Current QOPI measures (and associated modules) address the following:
• Documentation of care, including confirmation of cancer diagnosis and stage.
• Chemotherapy planning and administration.
• Pain assessment and control.
• Breast cancer management.
• Colorectal cancer management.
• Non-Hodgkin lymphoma management.
• Non–small-cell lung cancer management.
• Care at end of life.
• Symptom and toxicity management.
As noted, examples of core documentation of care measures include having the pathology report available in the patient's medical record, documenting a treatment plan, obtaining consent for chemotherapy, and recognizing and addressing pain. Examples of measures for disease-specific modules include assessment of appropriate pathologic exams, stage-specific recommendations, and achievement of administration of antineoplastic therapy in accordance with recognized guidelines. Examples of symptom and toxicity management measures include use of antiemetics and growth factors in accordance with guidelines, and fertility preservation and counseling.
What Early QOPI Data Showed
Early data abstraction (spring 2007) revealed that while 90% of patients received recommended care for breast and colon cancer management measures, fewer than half of patients received care at the end of life that was concordant with the measures assessed (eg, hospice enrollment, palliative care referral, assessment of pain and dyspnea, etc). Results have shown that performance on certain measures varies widely among participating practices. For example, while documentation of staging within one month of the initial practice visit was done for 83% of patients, 17% of charts did not provide stage in that time period, and in one practice, 60% of charts did not provide documentation of staging.
There is no preconceived expectation in QOPI that all measures should be achievable in 100% of patients. Truly ideal practice, which accounts for patient consent and variability, may well provide perfect care with less than 100% concordance with measures. Some patients (for example, a person with blastic bone lesions and a prostate specific antigen level of 10,000 ng/mL, or an Alzheimer's patient with a rock hard breast mass, hepatomegaly, and multiple enhancing lesions on brain imaging) may not require pathologic confirmation of malignancy.
Practices can benchmark their score to that of their peers, which is extremely valuable to smaller remote practices that have no other means of assessing the care they provide. Low adherence rates for certain measures likely occur for a variety of reasons, such as slow diffusion of knowledge, disagreement with guideline recommendations, or patient factors.