Standard setting is fundamental to professional organizations, and a core feature of a profession is its ability to set its own standards. So said ASCO CEO and EVP Allen S. Lichter, MD, in an interview about the new joint chemotherapy safety standards established by ASCO and ONS.
This is ASCO's first foray into standards setting, and is part of a larger strategy that has been evolving over the years, he noted. “Moving into this domain with ONS in promulgating standards for the safe administration of chemotherapeutic agents is part of the maturation process of the specialty and of the two societies issuing the standards.”
ASCO intends to use the standards as part of its Quality Oncology Practice Initiative (QOPI) that will allow practices to submit their compliance data voluntarily to be reviewed and certified as a site that meets the standards set by the society. Dr. Lichter said that he expected to see many practices attempting to become successfully certified.
“At this point we think that these will be the reference standards for this work going forward. It is part and parcel of our quality program, and to assess quality there are three domains to look at: process, structure, and outcome.”
Until now, he explained, QOPI has looked at process, such as asking oncologists, “In a patient setting with these conditions, did you do X?”
The issuing of the chemotherapy standards now brings ASCO into the second structure stage, where oncologists can be asked, “Are you set up as an organization to safely administer chemotherapy, and do you have policies and procedures in place from a structural capacity to do this work?”
And the third domain, outcome, will begin as a pilot project next year with a breast cancer registry that will allow ASCO to look at outcomes.
“So eventually you will see QOPI grow to encompass the total spectrum from end to end of a quality monitoring program. Our overall objective is to make QOPI the standard program for medical oncology in the United States.”
He said that so far the early response to the standards had been very good, with many oncologists saying how pleased they were and how the effort was long overdue.
Now that the standards have been issued, ASCO will make them available to practices to become certified. This will entail two parts: meeting the chemotherapy standards through application, including ASCO's randomly auditing a percentage of sites, and compliance with the QOPI modules by meeting the benchmarks for effective practice.
After achieving those steps a practice will be deemed as meeting the QOPI quality standards, and ASCO will go a step further by informing insurance companies of the accomplishment. “We feel it's very important for us to do this because if we can create a single standard, then the profession and the payers can respect that standard,” Dr. Lichter said.
“If we don't do this, every insurer can create its own quality program, and that will make for mass confusion because everyone will query different things in different ways at different times with different patients with different terminologies.
“We hope that over time as a service to the profession we can establish QOPI as the single standard, and if you participate and are certified, then any payer interested in oncology will look to QOPI certification as the gold standard. We believe this is a necessity; otherwise it's just going to disintegrate into chaos.”