Memorial Sloan Kettering Cancer Center, New York, New York.
American Society of Clinical Oncology, Alexandria, Virginia.
J Natl Compr Canc Netw. 2022 Oct;20(10):1099-1106.e2. doi: 10.6004/jnccn.2022.7024.
Oral chemotherapy performance measures were first introduced into ASCO's Quality Oncology Practice Initiative (QOPI) in 2013. This study examined performance on these measures among QOPI-participating practices and evaluated whether it differed among practices based on meeting QOPI Certification Program standards.
A total of 192 QOPI-participating practices (certified, n=50 [26%]; not certified, n=142 [74%]) reported performance on oral chemotherapy measures in 2017 and 2018. Inclusion was limited to practices reporting on ≥3 charts for ≥1 oral chemotherapy measure. Performance was defined as the percentage of charts examined that adhered to the measure. Descriptive analyses were used to characterize performance within and across practices, and mixed-effects logistic regression models were conducted to compare performance based on certification status.
Median performance across practices for the 9 oral chemotherapy measures examined ranged from 44% (education before the start of treatment addressing missed doses, toxicities, and clinical contact instructions [composite measure]) to 100% (documented dose, documented plan, and education about toxicities). Certified practices were more likely to provide education about clinic contact instructions than noncertified practices (odds ratio, 4.87; 95% CI, 1.00-24.0). Performance on all other measures was not significantly associated with certification status.
There is wide variability in quality related to performance on oral chemotherapy measures across all QOPI-participating practices, and several areas were identified in which administration of oral chemotherapy could be improved. Our findings highlight the need for the development and implementation of appropriate standards that apply to oral chemotherapy and address the complexities that set it apart from parenteral treatment.
口服化疗绩效指标于 2013 年首次纳入 ASCO 的肿瘤质量实践倡议（QOPI）。本研究考察了参与 QOPI 的实践在这些指标上的表现，并评估了根据 QOPI 认证计划标准的满足情况，这些实践之间的表现是否存在差异。
共有 192 家参与 QOPI 的实践（认证，n=50[26%]；未认证，n=142[74%]）在 2017 年和 2018 年报告了口服化疗措施的表现。纳入标准限于报告≥3 份≥1 种口服化疗措施的图表。表现定义为经审查符合措施的图表百分比。采用描述性分析对实践内和实践间的表现进行特征描述，并采用混合效应逻辑回归模型比较认证状态下的表现。
在所检查的 9 项口服化疗措施中，实践间的中位数表现范围从 44%（治疗开始前关于漏服、毒性和临床联系说明的教育[综合措施]）到 100%（记录剂量、计划和毒性教育）。认证实践提供有关临床联系说明的教育的可能性高于非认证实践（优势比，4.87；95%置信区间，1.00-24.0）。所有其他措施的表现与认证状态均无显著关联。
所有参与 QOPI 的实践在口服化疗措施表现方面存在广泛的质量差异，在口服化疗管理方面有几个领域可以得到改善。我们的研究结果强调了制定和实施适用于口服化疗并解决其与肠外治疗不同的复杂性的适当标准的必要性。
