2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

IMPROVING VALUE OF CARE IN ONCOLOGY
Table 1. QOPI Participation and QOPI Certification Compared
Program QOPI Participation QOPI Certification
Cost to ASCO Members Free $3000–15,000 (Depending
on practice size and
number of locations)
Measures 89 questions in 7
modules [1]
Passing score on 5 modules
(Currently, score to pass is
72% on general measures,
80% on appropriate
adjuvant treatment)
Standards Not applicable Documented policies
consistent with 17 of
ASCO/ONS chemotherapy
administration [i]standards
External Audit No Yes
Duration of Certification Not applicable 3 years
Comments Comparative data are
available to help a
practice measure its
achievement
Pricing is variable for larger
groups
Abbreviations: QOPI, Quality Oncology Practice Initiative; ONS, Oncology
Nursing Society.
ASCO requests that each QOPI practice identify a practice
steward who will take responsibility to educate practitioners
about their achievement in QOPI. Our experience in
distributing these results in both community and academic
settings has been that physicians accept the good results
with a tremendous amount of pride, and simultaneously
doubt the reliability or importance of measures where their
performance lags. Nevertheless, they almost always improve
their performance in these areas, although it is very
difficult to determine whether true performance or documentation
of performance is really changing. From personal
experience, one of the authors (MNN) notes that he has
learned much and changed how he interacts with patients.
For example, he is much more attentive to infertility counseling
and interventions before starting chemotherapy and
trying to prevent constipation in patients on narcotic analgesics
than previously.
QOPI certification of a large academic practice such as
Vanderbilt-Ingram Cancer Center poses challenges. Just
like preparing for any serious certification exercise, such as
the Commission on Cancer, Joint Commission, or Magnet
Nursing Certification, it is a significant team effort that
requires commitment of time and resources. Achieving certification
requires that a practice surpass a threshold
achievement level during a round of data submission and
demonstrate compliance with a subset of the chemotherapy
administration safety standards developed by ASCO and
ONS. 27 The number of charts needed for review is dependent
on the practice size (Table 1).
The benefits of participation and certification vary by
institution. The intrinsic reward—assessing practice or
practitioner performance—is great. Other benefits are possible.
Listing of certification has likely attracted some patients.
More tangible advantages have been realized by some
practices. For example, some practices have been provided
payment bonuses from payers. Some exclusive quality programs
recognize participation or certification as part of
inclusion standards. Finally, some practices have negotiated
rate premiums from payers based on the achievement of
certification (though antitrust concerns preclude any specific
detailing of these arrangements).
In summary, QOPI participation and certification require
significant effort associated with nontrivial expenses for
practices. There are intrinsic rewards and the opportunity
for self-examination and improvement with even a partial
data submission, although full and broad participation and
benchmark comparisons offer more.
The ASCO Rapid Learning System (RLS)
The field of oncology is entering an unprecedented time
where advances in technology, drug development, treatment
techniques, genomics, and research are driving health care
costs to unsustainable levels. 28 As a result, there is an
increasing need for higher quality care, at lower costs, with
better outcomes. To meet these needs and demonstrate
success, each component (quality, cost, and outcomes) must
be accurately defined, measured, and reported. Fortunately,
we have defined quality measures in oncology (QOPI), costs
can be captured via claims and other means, and outcomes
can be defined and reported though electronic medical record
(EMR) systems. Unfortunately, all of these data reside
in many different electronic (sometimes paper) systems that
do not interconnect. If these important data continue to
reside in many disparate systems, reporting high-value
cancer care will be burdensome or impossible. However,
there is a solution on the horizon: a learning health care
system. As defined by the Institute of Medicine, a learning
health care system is grounded in the principles of improving
effectiveness, safety, efficiency, and quality, paired with
evaluating the processes shared by engineering and medicine.
29 ASCO is taking the lead to develop a rapid learning
health system in oncology to accomplish the goal of improving
effectiveness, safety, efficiency, and quality in oncology.
The ASCO RLS will have the ability to utilize evidencebased
medicine in the form of publications, guidelines, and
measures, pair it with patient-level data from multiple
Health Information Technology systems, aggregate it, analyze
it, and turn the data into usable knowledge.
QOPI provides a uniquely strong foundation, but ASCO
recognizes that members and the oncology community will
benefit from an initiative with even greater sophistication.
In 2011, the ASCO Board directed that immediate work
begin on construction of a cutting-edge rapid learning system
for oncology.
What Is a Rapid Learning System?
In the most basic form, an RLS is a technology platform
that allows for the collection of data from different health
information technology systems to be collected, aggregated,
analyzed, and turned into usable information to improve
treatment and drive scientific learning and discovery from
every patient at every encounter (Fig. 2). 30 From a culture
standpoint, an RLS speeds and improves how we learn
(Fig. 3).
What Can We Do With an RLS?
The output from an RLS is potentially unlimited. The
community will have the ability to obtain real-time clinical
decision support, identify patients for clinical trials, conduct
population health research, conduct health outcomes research,
conduct comparative effectiveness research, provide
quality benchmarking, possibly use for REMS reporting,
and identify rare adverse events by detecting early warning
signals.
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