Center for Learning Health Care, Duke Clinical Research Institute, Durham, NC, USA.
J Oncol Pract. 2013 May;9(3):e86-9. doi: 10.1200/JOP.2013.000923.
A growing set of quality measures is being implemented to evaluate all components of cancer care, from diagnosis through the end of life. We investigated the Quality Oncology Practice Initiative (QOPI) quality measures portfolio. Additionally, we explored the effect of quality measure type on conformance.
We performed QOPI data collections twice per year from fall 2007 through fall 2010 and spring 2012, using chart review of the Durham Veterans Administration outpatient oncology clinic. We categorized QOPI measures as nontreatment-related supportive care (NTSC), treatment-related supportive care (TSC), diagnostic, or therapeutic. Descriptive statistics and χ(2) were used to compare longitudinal conformance.
The majority of QOPI measures in spring 2012 assess processes of chemotherapy treatment (therapeutic, 54.3%; TSC, 8.7%) or diagnostic modalities (19.6%). Measures targeting NTSC are few (17.4%) but increased from three measures in fall 2007 to eight measures in spring 2012. During those 5 years, average conformance to NTSC, TSC, diagnostic, and therapeutic measures was 71.4%, 86.1%, 89.3%, and 75.4%, respectively (P < .001). Within the NTSC measures, emotional well-being and constipation assessment were least documented (41.0% and 46.3%, respectively). In spring 2012, NTSC measure conformance (75.8%) remained significantly lower than diagnostic measure conformance (91.5%; P < .001).
Most QOPI quality measures assess diagnosis or treatment processes of care and not supportive care. Aggregate conformance to the NTSC measures was lower than that of other categories. The differential conformance demonstrates the necessity of standardized documentation methods and quality improvement efforts that remain commensurate with the increasing portfolio of supportive care measures.
为了评估癌症治疗的所有环节（从诊断到生命末期），越来越多的质量指标被应用到实践中。我们调查了肿瘤质量倡议（QOPI）的质量指标组合。此外，我们还探讨了质量指标类型对一致性的影响。
我们在 2007 年秋季至 2010 年秋季和 2012 年春季期间，每年进行两次 QOPI 数据采集，使用图表回顾达勒姆退伍军人事务部门诊肿瘤诊所的病历。我们将 QOPI 指标分为非治疗相关支持性护理（NTSC）、治疗相关支持性护理（TSC）、诊断或治疗。使用描述性统计和 χ(2)检验比较纵向一致性。
2012 年春季的 QOPI 指标中，多数指标评估化疗治疗过程（治疗性，54.3%；TSC，8.7%）或诊断方式（19.6%）。针对 NTSC 的指标很少（17.4%），但从 2007 年秋季的 3 项增加到 2012 年春季的 8 项。在这 5 年中，NTSC、TSC、诊断和治疗措施的平均一致性分别为 71.4%、86.1%、89.3%和 75.4%（P <.001）。在 NTSC 指标中，情绪健康和便秘评估的记录最少（分别为 41.0%和 46.3%）。2012 年春季，NTSC 措施的一致性（75.8%）仍然显著低于诊断措施的一致性（91.5%；P <.001）。
大多数 QOPI 质量指标评估诊断或治疗护理过程，而不是支持性护理。NTSC 措施的综合一致性低于其他类别。这种差异表明，需要标准化的文档记录方法和质量改进措施，这些措施与不断增加的支持性护理措施保持一致。
