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Persistence of quality improvement in a Veterans Affairs (VA) academic practice assessed by Quality Oncology Practice Initiative (QOPI).

Publication ,  Journal Article
Williams, CD; Kamal, A; Kelley, MJ
Published in: J Clin Oncol
December 2012

209 Background: The success of quality improvement (QI) efforts is usually assessed initially within a year of implementation but performance may later decline. We sought to determine the longer-term effectiveness of practice improvement interventions and the characteristics of interventions associated with persistent improvement. METHODS: The Durham VA Hem-Onc fellowship program affiliated with Duke University participated in QOPI twice yearly in 2007 to 2010 and Spring (Sp) 2012. Four interventions were implemented focused on treatment planning (TP; Sp07), treatment summary (TS; Fa07), consent (C; Sp07), and aprepitant use (A; Sp09). Effectiveness was determined by reassessment of 4, 3, 1, and 1 measures, respectively. The TP, TS, and C interventions were policy-dictated use of templated documentation or written consent, and, for TP and C, required conformance prior to chemotherapy administration; TS is not linked to a process. The A intervention modified order set templates to include A for highly emetogenic regimens. For each measure, we compared conformance pre-intervention with post-intervention conformance and, for quality indicators not targeted for improvement, the baseline with each subsequent assessment using chi-square. RESULTS: Considering only measures in the core or symptom management modules with unchanged or similar definitions throughout the study period, 13 of 28 measures had conformance > 85% in the baseline 2007 data. TP conformance increased from 64% to 88, 94, 92, and 96% in subsequent years (p < 0.01). TS was 45% at baseline, 43% (p = NS) in the first post-intervention year, decreased to 24% for two years (p < 0.01) and then increased to 38% (p = NS). C increased from 64% to 97, 91, 94, and 100% (p < 0.01). Conformance with A increased from 9% to 78 and 86% (p < 0.01). Among measures not targeted by intervention, smoking assessment and counseling increased in later years. CONCLUSIONS: In this single practice experience, QI improvement interventions integrated into physician processes resulted in substantial and persistent improvement while no improvement was observed as a result of policy-required use of standard documentation alone.

Duke Scholars

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 2012

Volume

30

Issue

34_suppl

Start / End Page

209

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Williams, C. D., Kamal, A., & Kelley, M. J. (2012). Persistence of quality improvement in a Veterans Affairs (VA) academic practice assessed by Quality Oncology Practice Initiative (QOPI). J Clin Oncol, 30(34_suppl), 209. https://doi.org/10.1200/jco.2012.30.34_suppl.209
Williams, C. D., A. Kamal, and M. J. Kelley. “Persistence of quality improvement in a Veterans Affairs (VA) academic practice assessed by Quality Oncology Practice Initiative (QOPI).J Clin Oncol 30, no. 34_suppl (December 2012): 209. https://doi.org/10.1200/jco.2012.30.34_suppl.209.
Williams, C. D., et al. “Persistence of quality improvement in a Veterans Affairs (VA) academic practice assessed by Quality Oncology Practice Initiative (QOPI).J Clin Oncol, vol. 30, no. 34_suppl, Dec. 2012, p. 209. Pubmed, doi:10.1200/jco.2012.30.34_suppl.209.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

December 2012

Volume

30

Issue

34_suppl

Start / End Page

209

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences