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Evidence-Based Oncology July 2016

Clinical Interpretation of the ASCO Recommendations on Quality and Value

Surabhi Dangi-Garimella, PhD
A session at the annual meeting of the American Society of Clinical Oncology (ASCO) provided an overview of the ASCO value framework and it's quality improvement program, the Quality Oncology Practice Initiative.
The American Society of Clinical Oncology (ASCO) recently published an update1 to the value framework as the next step toward the goal of providing clinicians and patients with a tool for shared decision making. Providing an overview of the framework and ASCO’s quality program,2 the Quality Oncology Practice Initiative (QOPI), was the session Quality and Value: Measuring and Utilizing Both in Your Practice.

Anne C. Chiang, MD, PhD, Yale Cancer Center, provided an overview of the QOPI certification program and explained the impact that this certification could have on the quality of care provided by clinical practices. “The current landscape of oncology is a combination of new immunotherapeutic agents, genomics and precision medicine, technology, and big data,” Chiang said, adding that it’s a difficult process, trying to balance quality and value of such innovative treatments.

“QOPI is ASCO’s signature quality program. Over 1000 practices with 7000 participants have participated in QOPI since 2006,” Chiang said, with widespread geographic distribution of the practices that have registered with the program within the United States. Additionally, the QOPI program has crossed international boundaries, and 16 international practices have registered with the program in fall 2015.  

So why does QOPI matter? “It’s not just about the cost,” Chiang said, “but it’s also about creating a culture of quality, tools for measurement, benchmarking and standardization opportunities, and driving performance improvement.” She provided an example of the Smilow Cancer Center at Yale, which implemented several quality improvement projects, including:
  • EPIC, the electronic health record system
  • QOPI certification
  • An oral chemotherapy initiative
  • SRC care center emotional distress project
The cancer center wanted improved standardization across its various sites of care. Following the integration of QOPI practices, a significant improvement in documentation of data was observed at the various clinical sites, Chiang said.

The QOPI certification program also touches various aspects of patient care, and it helps,
  • Make the right diagnosis
  • Determine the treatment plan
  • Communicate with the patients
  • Shared decision making
According to Chiang, Smilow is using QOPI to raise the bar for disagreements on pathology referrals, especially when they are conducted at outside labs. “QOPI also provides important tools to comply with MACRA [Medicare Access and CHIP Reauthorization Act], and the Physician Quality Reporting Pathway will help comply with the requirements of MIPS, the merit-based intervention payment system. The QOPI/QCP community is both a quality forum and test ground for evolving solutions to MACRA and future challenges,” Chiang said.

ASCO’s Value Framework
Lowell E. Schnipper, MD, PhD, Beth Israel Deaconess Medical Center, discussed the nuances of the value framework. “The context in which we are entering this space is a new era of treatments that we are utilizing in clinical practice every day,” Schnipper said. “Several of these treatments are game changers in care. But these treatments are expensive, and insurance is getting unaffordable for most in the middle-income strata of society.”

“We anticipate that the tool we have developed can help patients and providers make treatment decisions. We hope to collaborate with software vendors who can help develop an app for use at the physician-patient interface,” Schnipper said. He went on to explain the Net Health Benefit score, or NHB, which has several domains that are regularly used in the clinic, including the biggest domain: clinical benefit. When calculating the NHB, overall survival is valued above progression-free survival, which in turn is above response rate (RR).

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