The evolution of supportive care quality measures portfolio and conformance.

259 Background: A growing set of quality measures is being implemented to evaluate all components of cancer care ranging from diagnosis through the end-of-life (EOL). With an increasing emphasis from ASCO and others on the regular delivery of supportive care principles throughout the cancer trajectory, we investigated our longitudinal Quality Oncology Practice Initiative (QOPI) data to understand the trends in supportive and EOL measures. METHODS: We performed twice-yearly QOPI data collections from 2007 through Spring 2012 using chart review of the Durham Veterans Administration (VA) outpatient oncology clinic, staffed by VA and Duke faculty as well as Duke fellows. QOPI measures were categorized as non-treatment related supportive care (SC) (NTSC), treatment-related SC (TSC), diagnostic (D), or therapeutic (T). Descriptive statistics and chi square were used to compare longitudinal conformance. RESULTS: The majority of QOPI measures assess processes of chemotherapy treatment (49.1% T and 11.1% TSC) or diagnostic modalities (21.1% D). Measures targeting NTSC are few (18.6%), but increased from two SC measures in 2007 to eight in Spring 2012, including the addition of two EOL measures. Over the five years, average conformance to NTSC, TSC, D, and T measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (p<0.001). Within the NTSC measures, emotional well-being, and constipation assessment were least documented (41.0%, and 46.3% respectively). In Spring 2012, SC measure conformance (76.0%) remained significantly lower than D measure conformance (91.5%) (p<0.001). Potential explanations include heterogenous and non-standardized ways to document non-treatment measures despite an increasing emphasis within cancer care on supportive and palliative care. CONCLUSIONS: Most QOPI quality measures assess diagnosis or treatment processes of cancer care. Aggregate conformance to the NTSC measures was lower than other categories over five years. This disparity persists in the latest 2012 collection, and novel SC measures have been added. The differential conformance demonstrates the necessity of quality improvement efforts that stay commiserate with the increasing portfolio of SC measures.

Duke Scholars

Author Michael John Kelley Medicine, Medical Oncology