Opinion articles

Saturday, May 7, 2011

ONLINE FIRST: BY ASCO CEO: QOPI: Helping Practices Achieve the Highest Level of Quality

Monitoring and improving the quality of the oncology care we provide is a bedrock professional responsibility. Because of our desire to practice at the highest level, many different quality programs are being heavily marketed to practices and academic institutions. As a result, practices are burdened with numerous programs, measurements, and requirements leading to quality measurement that is fragmented.


With more consumers using quality data and payers, including the Centers for Medicare and Medicaid Services (CMS), exploring the possibility of linking payments and updates with quality measurement, making quality measurement meaningful and accurate is more important than ever. When it comes to medical oncology, let’s look at a leading program that is working well.


In 2006, the American Society of Clinical Oncology launched the Quality Oncology Practice Initiative (QOPI®) which is the first national program to help oncology practices improve the quality of care.  QOPI consists of oncologists, as professionals, monitoring each other, holding each other accountable, and advancing the quality of care together.


QOPI’s rigorous set of more than 90 quality measures was developed by practicing oncologists and quality experts, and it spans the continuum of cancer care. The metrics are based on best practices derived from clinical guidelines, published measures, and collective expert consensus. Practices that participate in this program receive detailed reports about their performance level, allowing comparisons with other practices across the nation and highlighting specific areas for improvement.


The QOPI Certification Program was launched in January 2010. This recognition program for outpatient oncology practices is the first program of its kind for oncology in the United States. Oncologists can achieve certification by demonstrating practice consistent with the highest standards of care, which includes meeting QOPI’s 24 core measures and 17 ASCO/Oncology Nursing Society safety standards for administering chemotherapy.


One-fourth of the oncology practices in the United States have voluntarily participated in QOPI. Currently, more than 700 practices are registered in the program, and more than 60 have received certification.


As molecular pathways in cancer treatment are understood and patients come to practices with a printout summarizing their entire genome sequence, practices will need to have decision-support resources and a quality program by their side to ensure that the optimal treatment or clinical trial is matched to each patient. Absent such a support system, we simply won’t be able to keep up with the complexity of the care.


We are on the cusp of entering what some have called the rapid-learning healthcare system, where information flows freely between practices and patient registries and back again, incorporating scientific discovery, clinical guidelines, performance measurement, and individual patient experiences.


Access to real-time clinical data will greatly enhance insight to patient outcomes and drive clinical research.  For practices striving to assess and improve their quality of care, being in this loop will be essential.


We know we have a long way to realizing the Rapid Learning Oncology Care System (RLOCS). While QOPI’s 91 measurements for solid tumors are 10 times more than the metrics offered by quality programs used by federal agencies, we realize that we are just scratching the surface and will have to expand to accommodate all aspects of cancer care.


To make this system function appropriately, QOPI will have to become fully electronic so that data from the patient’s electronic record is abstracted seamlessly in real-time — without adding work or administrative burden to already straining practices.


The technical challenges to making this happen can be overcome. Two other fields — cardiology and thoracic surgery — have made tremendous progress in patient registries and quality measurement. They’ve been at it much longer than we have, but the energy and commitment that has made QOPI a reality can be leveraged to make the same kind of progress. We at ASCO are working towards evolving QOPI into the RLOCS.


It will not be completed in months, but we can start down that path today. We hope that every member of the oncology community will work with us.


For more information on QOPI and how your practice can participate, please visit qopi.asco.org.



Allen S. Lichter, MD, is Chief Executive Officer of the American Society of Clinical Oncology. Prior to this appointment, Dr. Lichter served for two decades at the University of Michigan, first as Chair and Professor of Radiation Oncology, and subsequently as Dean of the Medical School (1998-2006).