Pursuing High-Quality Cancer Care in Brazil With QOPI Certification Program

Feb 21, 2018

In January 2018, Clinica AMO joined the elite group of practices whose demonstrated commitment to high-quality care has led to Quality Oncology Practice Initiative (QOPI®) Certification. This 3-year certification indicates that an outpatient oncology/hematology practice has met the highest standards for safety and quality of care delivery.

Clinica AMO is located in Salvador (a city of about 3.5 million people and the capital of the state of Bahia) and is the largest oncology practice in northeastern Brazil. Clinic president Carlos Sampaio, MD, and medical director Alex Pimenta, MD, describe the unique barriers to delivering quality care that Brazilian providers face, and the valuable lessons they learned through the process of achieving QOPI Certification.

What led to your interest in ASCO’s QOPI Certification ProgramTM?

CS and AP: Our practice in Salvador has evolved to a multidisciplinary approach, and among over 130 physicians working at AMO, 30 are medical oncologists or hematologists. Due to our early commitment to safe and high-quality care, AMO started a formal accreditation pathway in 2013, leading us to achieve ONA III level (a Brazilian system based on international practice standards). Despite that, we were in need of a quality program focused on cancer care. Our first contact with the QOPI Certification Program took place during the 2014 ASCO Annual Meeting in Chicago. Our goal to pursue quality metrics and improve our standards moved us to apply for the program as soon as it was made available to Brazilian institutions.

What unique barriers to quality improvement do practices have to overcome in Brazil?

CS and AP: Brazil is more than one single evenly distributed country. It covers the entire spectrum of social and technologic development, providing very unequal care to its more than 200 million citizens. There are both private and public centers of excellence. The majority of our population, however, has limited access to private health care and relies solely on government-run institutions; the current reality for 70% of Brazilians is that the available care is suboptimal.

Limited funds and bureaucracy are our major obstacles. By constitutional law, all Brazilian citizens are entitled to receive health care provided by the federal, state, and county governments for “free.” Unfortunately, schedule delays, long waiting times for surgery and radiation therapy, and outdated systemic therapy protocols are the norm in most public institutions.

Meanwhile, a robust private segment of health care coexists with the public system and embraces 25% of the population. At these private centers, the care available is comparable to the best centers in high-income countries and patients have access to state-of-the-art diagnosis and treatment. Our challenge, as seen in many other countries, is to find ways to better invest government resources, and focus on prevention and early diagnosis, without compromising cancer care for our patients.

What did you learn from participating in the QOPI Certification Program, and how will you use that knowledge to help others?

CS and AP: The QOPI Certification Program provided us an opportunity to realize that, despite being a great challenge, standardization of medical procedures and registries is an achievable objective. We learned a lot of lessons as we went through the certification process, including how important it is to guarantee that all patients receive evidence-based care, from pain management to molecular diagnosis or targeted therapy.

It additionally turned out to be an excellent platform for training our new staff. We were able to use the program as a tool to make them familiar with the concept of institutional policies and their impact on the quality of care provided.

What cultural differences made it challenging to achieve QOPI Certification standards in Brazil?

CS and AP: There are major cultural differences in how patients are informed of their disease and prognosis in Brazil as compared to the United States. In Brazil, most physicians thoroughly explain clinical scenarios to patients and family members, but many patients elect to delegate most decisions to the health care team. There is also less legal pressure to maintain a detailed registration of available options and decisions.

Clinica AMO has a well-structured electronic medical record (EMR) system that was implemented in 2000 and has been updated constantly. In order to comply with some of the QOPI metrics, we had to make inclusions and adjustments to our EMR system that improved our standard of care.

What do you see as the role for organizations such as ASCO to support quality and safety in cancer care internationally?

CS and AP: We would like to commend ASCO for making QOPI and the QOPI Certification Program an international effort. In our opinion, this initiative, because it is focused on and dedicated to cancer care, provides a unique opportunity to improve patient care across diverse scenarios. QOPI metrics are easy to understand and rationally applicable in daily practice. As we learn and move along the QOPI process we immediately sense improvements in our institutional standards. It has been a rewarding experience for our entire team at AMO. 


Carlos Augusto Albach, MD

Mar, 14 2018 12:34 PM

Congratulations for your achievement. It is always great to see good examples that can be used as a benchmark for future improvements in our healthcare system, namely in Oncology Care. I wonder if there is other outpatient clinics in Brazil with the same certification. What is the EMR system you´re currenlty using? Kind regards, Carlos.

Carlos Alberto Sampaio-Filho, MD

Mar, 15 2018 12:52 PM

Thank you for your comments Dr Albach.

We have been using and contributing to develop the “SMART” system from Medicware/Pixeon since 2000. The system is used by a number of outpatient practices and hospitals across Brazil.

AMO and IOV, a very well conducted clinic from São Paulo and lead by my colleague Dr. Carlos Frederico, are the first two QOPI certified clinics in Brazil.

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