title: American Society for Radiation Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment: A practical approach for informing practice improvement.
abstract: OBJECTIVE
  Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT) is a practice quality improvement program. This study seeks to determine baseline performance rates and practice variation from PAAROT data.
  
  
  METHODS
  The cohort includes all physicians from academic, hospital, and free-standing settings who completed at least 10 consecutive self-audited medical records in the PAAROT program (version 2.5) from 2010 to 2011 (n = 519 medical records). Mean performance rates were analyzed at the physician and medical record levels and, where appropriate, were stratified by the physician's practice setting.
  
  
  RESULTS
  Forty-nine physicians were included in the study; 22 (45%), 17 (35%), and 10 (20%) physicians practiced in a hospital, academic, or a free-standing setting, respectively. The measures with a high adoption rate (more than 80%) include the following: documentation of history and physical; review of physics and dosimetry plan by radiation oncologist; patient informed risks of therapy; evaluation of acute symptoms during therapy; pathology in consultation note; communication of treatment summary within 30 days of treatment completion; documentation of intent of treatment, use of clinical guidelines or published data; and documentation of American Joint Committee on Cancer staging. Lower rates of adoption were noted (mean, 65%; range, 0-100%) when these measures were converted to a composite measure. Low adherence was noted for screening of a pain using a standard scale (mean, 58%; range, 0-100%). Physicians from an academic setting scored higher on the composite measure (40%) compared with those from a hospital setting (36%) and from a free-standing setting (24%); (P < .001). Physicians from a hospital setting scored higher on the quality indicator of screening for pain (54%) compared with physicians from an academic setting (35%) and free-standing setting (11%) (P < .001).
  
  
  CONCLUSIONS
  This first assessment of PAAROT (version 2.5) data provides an initial snapshot on the use of quality indicators and practice patterns for radiation oncology. Self-reported practice data and the use of quality indicators will become important for the purpose of continuous, prospective evidence-based learning on an individual basis. Despite the small sample size, the data from this study will help address potential improvement opportunities for the next iteration of the PAAROT program.
authors.affiliation: American Society for Radiation Oncology, Fairfax, Virginia. Electronic address: anushreev@astro.org.
authors.forename: Anushree
authors.initials: A
authors.lastname: Vichare
authors.affiliation: American Society for Radiation Oncology, Fairfax, Virginia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Eads
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Rinaa
authors.initials: R
authors.lastname: Punglia
authors.affiliation: North Shore-Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Potters