The Institute of Oncology (IOV) is using the ASCO’s QOPI since 2013 in Brazil. QOPI is a retrospective analysis by data abstraction submited to a database pulling over 180 quality measures based on care guidelines and expert consensus. Data collection are twice a year and provides reports based on practice wide data sample comparing overall quality score for the practice and for the participants aggregate.
IOV participates in rounds at least once a year. At each round current performance is reviewed and select gaps are translated into improvement projects that focus on meaningful use of resources, safety, accountability of care, and value. Meaningful use of PET-CT; lab tests; and G-CSF are samples of specific projects the past. IOV's Patient Navigation System (PNS) was adapted to track QOPI standards/measures that are monitored by clinical navigators as checkpoints in real time transitions of care and handovers. Potentially hazardous checkpoints are actively chased using a daily signaling process.
Between Feb/2016 and Mar/2017, the PNS checked 9,372 patient iteractions (surgery, exams, outside appointments, optimal sequencing of care); 138 (1.5%) potentially hazardous events were identififed and managed in advance: missing “readiness to care data” and lab tests (36%); delayed radiation or chemo (38%); delayed surgery (7%); and missing echocardiogram for patients using cardiotoxic drugs (6%). The Pain Management Navigation System was created to meet another set of QOPI measures that also translated into 17% reduction of emergency room admissions for 141 patients involved. A dedicated flow was created to meet oral chemo standards, and patient satisfaction improved from 67% to 93% by reducing door-to-door time from 40 to 12 minutes, including check in, interview, drug refill and reconciliation.
One of the big challenges of healthcare is how to introduce changes that translates into real improvements. The use of evidence-based measures and standards to evaluate quality of care provides a clear and straight path to deliver higher value; meaningful use of resources; focus and alignment for improvements initiatives where it matters most: patient care and outcomes.
Clinical trial identification
Legal entity responsible for the study
Instituto de Oncologia do Vale
C.F. Pinto: Board Member at Institute of Oncology. All other authors have declared no conflicts of interest.