A process for measuring the quality of cancer care: the Quality Oncology Practice Initiative.
OBJECTIVE
The Quality Oncology Practice Initiative (QOPI) is a practice-based system of quality self-assessment sponsored by the participants and the American Society of Clinical Oncology (ASCO). The process of quality evaluation, development of the pilot questionnaire, and preliminary results are reported.


METHODS
Physicians from seven oncology groups developed medical record abstraction measures based on practice guidelines and consensus-supported indicators of quality care. Each practice completed two rounds of records review and received practice and aggregate results. Mean frequencies of responses for each indicator were compared among practices.


RESULTS
Participants universally, if informally, find QOPI helpful, and results show statistically significant variation among practices for several indicators, including assessing pain in patients close to death, documentation of informed consent for chemotherapy, and concordance with granulocytic and erythroid growth factor administration guidelines. Measures with universally high concordance include the use of serotonin antagonist antiemetics according to the ASCO guideline; the presence of a pathology report in the record; the use of chemotherapy flow sheets; and adherence to standard chemotherapy recommendations for patients with certain stages of breast, colon, and rectal cancer. Concordance with quality indicators significantly changed between survey rounds for several measures.


CONCLUSIONS
Pilot results indicate that the QOPI process provides a rapid and objective measurement of practice quality that allows comparisons among practices and over time. It also provides a mechanism for measuring concordance with published guidelines. Most importantly, it provides a tool for practice self-examination that can promote excellence in cancer care.
Neuss
Michael N
MN
Oncology Hematology Care, 4725 E Galbraith, Suite 320, Cincinnati, OH 45236, USA. mneuss@ohcmail.com
Desch
Christopher E
CE
McNiff
Kristen K
KK
Eisenberg
Peter D
PD
Gesme
Dean H
DH
Jacobson
Joseph O
JO
Jahanzeb
Mohammad
M
Padberg
Jennifer J
JJ
Rainey
John M
JM
Guo
Jeff J
JJ
Simone
Joseph V
JV
D003625:Data Collection; D019983:Guideline Adherence; D006801:Humans; D007258:Informed Consent; D008495:Medical Oncology / Q000592:standards*; D008499:Medical Records / Q000706:statistics & numerical data; D010146:Pain / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D012955:Societies, Medical; D013727:Terminal Care