By Elyse Blye, Editorial Assistant

October 2010 Issue: The concept of ASCO’s Quality Oncology Practice Initiative, or QOPI^®, was first proposed to the Society’s Board of Directors in 2002 by Joseph V. Simone, MD. With a vision of ASCO as the international leader in promoting high quality cancer care, Dr. Simone set out on a mission to develop and promote a practical program that could measure progress, be used anywhere, and reward successful participants.

Today, more than 600 practices representing more than 800 individual practice sites are registered with QOPI. With this initiative, the quality of oncology care continues to improve across the country and beyond through site-specific and comparative data measurements, feedback, and improvement tools for hematology–oncology practices.

The state of Michigan, in particular, has provided an excellent model of how to effectively apply QOPI data measurement toward the improvement of care and standardization of procedures for oncology practices.

The beginning of a partnership

In 2004, Blue Cross^® Blue Shield^® of Michigan (BCBSM) developed a Physician Group Incentive Program (PGIP) “to encourage and incentivize physicians to more effectively manage populations of patients with chronic diseases and build an infrastructure to more robustly measure and monitor care quality,” as stated on its website.

The program is based on a reward pool created by BCBSM, in which 100% of funds are allocated to PGIPparticipating physician organizations. The funds are provided as a means to reward improvement and to cover the time, effort, and investment in the activities outlined by each practice’s specific initiatives.

Through BCBSM’s Value Partnerships program, under which the PGIP falls, BCBSM has financially supported quality improvement physician consortia in both hospital and ambulatory settings. Measuring processes and outcomes has allowed Michigan consortia to achieve (and publish) reductions in morbidity and mortality in cardiac catheterization, bariatric surgery, and cardiac surgery.

“Blue Cross Blue Shield proposed to Michigan oncologists a similar effort involving cancer,” explained Douglas W. Blayney, MD, former Medical Director of the University of Michigan Cancer Center and ASCO Immediate Past President. He now serves as the Ann and John Doerr Medical Director of the Stanford Cancer Center. More specifically, BCBSM showed an interest in measuring appropriate erythropoeitic stimulating agents and trastuzumab utilization.

Dr. Blayney and his colleagues informed BCBSM that these two processes of care were already being measured by QOPI, and that appropriate treatment for breast cancer, lung cancer, colon cancer, and appropriate use of antiemetics and hospice and other end-oflife services could also be measured. “Rather than creating a new program, we proposed QOPI to them,” he said.

QOPI in action
After several QOPI rounds by oncology practices participating in BCBSM’s PGIP, Michigan demonstrated that data collection was both possible and beneficial. “I was surprised and pleased to see that adherence to QOPI’s diseasebased measures was high across Michigan. Whether a patient was treated at the University of Michigan or in one of the community practices, they seemed to receive appropriate adjuvant treatment for their breast cancer and colon cancer,” said Dr. Blayney.

Other results showed higher utilization of chemotherapy at the end of life in the University practice than in community practices—something the University has since addressed and moved toward the community benchmark.

Other results included variation in the documentation around pain and its treatment, and the use of KRAS testing in patients with colon cancer—both of which are being evaluated.

With QOPI’s success, the partnership between Michigan oncology practices and BCBSM progressed even further with the creation of the Michigan Oncology Quality Consortium (MOQC) in July 2009.

“We formed MOQC as a quality improvement consortium, building on earlier, hospital-based consortia in other fields. MOQC intends to act as a learning collaborative, using QOPI data to identify processes in need of improvement, and then design and implement practice-based interventions,” Dr. Blayney said.

Moving forward
In the same spirit of working toward self-improvement, Dr. Simone recognizes that the QOPI program itself can and should be further developed. During his ASCO/American Cancer Society award lecture at the 2010 Annual Meeting, he stated: “To continue to be relevant and adaptive in the future, the quality measures must include outcome measurement, such as duration of remission and survival as well as the quality of life of patients. These are the issues most important to patients.”

QOPI participants also often mention the time and energy associated with data abstraction as an issue for consideration, according to Dr. Blayney. He suggests it would be beneficial to have automated links in electronic health records so that the devices could populate QOPI data fields without an intermediate human data extraction step.

Dr. Blayney also envisions a “road testing” or pilot phase prior to a broad implementation that could make data abstraction easier and keep more practices engaged in quality improvement, as some measures are time-sensitive. “For instance, we all agree that smoking cessation is a good thing and can prevent many cancers in the long run, and may increase survival of already diagnosed patients with cancer,” he said. “However, we’re struggling with what is the best moment to introduce smoking cessation into the physician–patient conversation, and how to easily measure this. Should it be discussed at the first meeting, the second meeting, or sometime within three months of the first encounter with an oncologist, and how easily is this [data] abstracted from an electronic or a paper-based chart?”

Words of advice
Dr. Blayney advises all current and prospective QOPI participants that when data for a practice is first measured, the results may be surprising. These surprises, however, “are not bad, they’ve just not been measured before, and they represent opportunities for improvement,” he said. “Don’t be embarrassed if the initial measurements turn out different than expected. Commit to the improvement.”

The QOPI Certification Program demonstrates a commitment to excellence and ongoing quality improvement in the hematology–oncology outpatient practice. The goals of the QOPI Certification Program are to:

• Promote the highest quality cancer care as defined by the clinician experts
• Provide a trusted solution to satisfy external demand for quality activities
• Reduce redundant programs or requirements for oncology practices, including health plan programs.

To view the first class of QOPI Certified practices and to learn more about QOPI or the certification program, visit qopi.asco.org.