Development and future of the American Society of Clinical Oncology's Quality Oncology Practice Initiative.

ion. In addition, QOPI was successful in establishing quality as a core competency of ASCO and led to the theme of “Enhancing Quality Through Innovation” as a presidential theme in 2010; to the QOPI certification program; and to the creation of CancerLinQ, a rapid-learning oncology system we describe later in this article. The QOPI certification program. The most important programmatic expansion of QOPI to date has been the development of the QOPI certification program. Launched in 2010 in response to requests to raise the bar for quality assessment and to demonstrate to external parties (eg, in marketing and to payers) an indication of quality achieved appropriate for sharing externally. The QOPI certification program provides a practice-level certification for oncologists that meet scoring requirements on QOPI measures and demonstrate compliance with safety standards. The challenge for ASCO in preparing the QOPI certification program was how to establish the requirements and thresholds of quality. Participation in QOPI measurement rounds was recognized as an important but insufficient achievement for practices. To be QOPI certified, a medical oncology practice is required to demonstrate proficiency in care delivery and evidence of patient safety practices. Demonstration of proficiency in care delivery means attaining high scores in five QOPI modules. Initially, evidence of patient safety meant compliance with seventeen of the ASCO/Oncology Nursing Society Standards for Safe Chemotherapy Administration; in 2013, the number of safety standards was expanded to 20. The initial step in applying for certification is submission of documentation. Source documents (ie, patient charts with identifiers removed) are checked against the QOPI database to ensure accurate data abstraction. Structured onsite audits, which also examine source documentation, policies and procedures, and adherence to stated policies, are conducted by advanced-degree oncology nurses. The audits were initially performed on randomly selected practices, but universal audits were begun in September 2011. In early experiences with the first 111 applicants to undergo onsite review, only two were fully concordant with all of the standards. Most practices were subsequently able to modify their practices to become QOPI-certified. With QOPI certification, practices are only required to participate in one data abstraction round per year, which reduces the data abstraction time required as a partial reward for certification. At the time of this writing, 275 practices have applied to become QOPI certified, and 220 have succeeded; 82 have applied for recertification after their 3-year term. Certified practices represent more than 2,022 oncologists Asco 50th Anniversary www.jco.org © 2014 by American Society of Clinical Oncology 3 Downloaded from jco.ascopubs.org on September 16, 2014. For personal use only. No other uses without permission. Copyright © 2014 American Society of Clinical Oncology. All rights reserved. in 43 states. QOPI certification program sites vary from a single physician practice to large multisite cancer programs and academic medical centers. The need to expand and evolve to meet participants’ needs. In the decade since the QOPI pilot began, external scrutiny and professional expectations for quality monitoring have expanded dramatically. Although QOPI was initiated as a grassroots self-assessment initiative, QOPI leaders found that the program had the potential to meet emerging requirements. This includes performance improvement requirements for medical board maintenance of certification and for continuing medical education. In addition, at the time of this writing, 75 medical oncology fellowship programs have used QOPI as a pathway to meet American College of Graduate Medical Education (ACGME) performance improvement training recommendations. The Path Forward: Plans and Ideas for the Future QOPI has demonstrated success with quality assessment, but ASCO and QOPI leadership know that the program must change and expand to meet ongoing member needs and the shifting environment. We seek to provide improvement tools and methodologies to continuously improve quality and maximize outcomes and value in oncology practice. We also hope to make it easy for oncologists to truly engage in quality measurement and improvement to minimize concerns that quality improvement is to be delegated to administration Table 2. Selected QOPI Articles