Bowen Ashley M, Cloud Aimee, Fadly Suzanne, Gennette Ryan, Hector-Word Zachary, Hirth Joann, Kier Yelena, Kostoff Diana, Kuriakose Philip, Malhotra Binu, Nourkeyhani Houman, Rana Jatin, DeVries Keli, Mackler Emily, Winsted Shawn, Voisine Eric, Griggs Jennifer J
Michigan Oncology Quality Consortium, Ann Arbor.
Munson Healthcare, Traverse City, Michigan.
JAMA Netw Open. 2025 May 1;8(5):e2510392. doi: 10.1001/jamanetworkopen.2025.10392.
Olanzapine as part of a 4-drug antiemetic regimen is highly effective at preventing nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC). National prescribing rates of olanzapine in eligible patients have, however, remained persistently low.
To describe efforts to increase the guideline-concordant use of olanzapine in patients receiving HEC in a statewide oncology collaborative.
DESIGN, SETTING, AND PARTICIPANTS: The Michigan Oncology Quality Consortium (MOQC) is a collaborative of Michigan-based oncology practices whose mission is to advance the care of patients with cancer and their caregivers through comprehensive, patient- and practice-led quality improvement initiatives. Participants were patients receiving HEC at 38 MOQC member practices during an initiative from 2019 to 2023 to improve guideline-concordant inclusion of olanzapine as part of a 4-drug antiemetic regimen in HEC prophylaxis.
Interventions included performance audit and feedback to practices along with peer comparison, learning collaboratives of practices, education by experts at collaborative meetings, creation of patient-facing materials, and the addition of value-based reimbursement beginning in 2021. Measure performance was assessed using the American Society of Clinical Oncology's Quality Oncology Practice Initiative.
Proportion of patients receiving olanzapine for the first cycle of HEC as part of a 4-drug antiemetic regimen for chemotherapy-induced nausea and vomiting.
Between 2019 and 2024, data were manually collected from the medical records of 8662 patients treated with HEC at 38 medical oncology practices at 71 sites across the state. Individual patient-level demographic data are not available from the QOPI database. For patients from years 2021 through 2024, the median (IQR) age was 62 (52-69) years; 4434 were female (65.5%); 814 were Black or African American (12.0%), 121 were Hispanic or Latino (1.8%), and 5385 were White (79.7%). The use of olanzapine as part of a 4-drug antiemetic increased from 7.2% in 2019 to 63.4% in 2024 (χ21 = 553.61; P < .001).
In this quality improvement study of olanzapine prescribing in eligible patients, MOQC deployed quality improvement methods to increase the prescribing of olanzapine as part of a 4-drug regimen in patients receiving HEC, well above both the baseline and national levels of prescribing. This work suggests that efforts to improve patient care can be effective across diverse practice types, locations, and sizes in a statewide collaborative. Ongoing efforts include supporting change in those practices with low rates of prescribing and demonstrating the importance of this work for patient outcomes.
奥氮平作为四药联合止吐方案的一部分，在预防接受高致吐性化疗（HEC）的患者恶心和呕吐方面非常有效。然而，符合条件的患者中奥氮平的全国处方率一直很低。
描述在全州肿瘤协作组中，为增加接受HEC的患者中符合指南的奥氮平使用所做的努力。
设计、背景和参与者：密歇根肿瘤质量联盟（MOQC）是一个由密歇根州肿瘤医疗实践组成的协作组织，其使命是通过全面的、以患者和实践为主导的质量改进举措，推进癌症患者及其护理人员的治疗。参与者是在2019年至2023年的一项倡议期间，在38家MOQC成员机构接受HEC的患者，该倡议旨在改善将奥氮平作为四药联合止吐方案的一部分用于HEC预防的指南依从性。
干预措施包括对医疗实践进行绩效审核和反馈以及同行比较、医疗实践学习协作组、协作会议上专家进行的教育、创建面向患者的材料，以及从2021年开始增加基于价值的报销。使用美国临床肿瘤学会的肿瘤质量实践倡议来评估测量绩效。
作为化疗引起的恶心和呕吐四药联合止吐方案的一部分，接受HEC的首个周期使用奥氮平的患者比例。
2019年至2024年期间，从全州71个地点的38家肿瘤内科医疗实践中接受HEC治疗的8662名患者的病历中手动收集数据。QOPI数据库中没有个体患者层面的人口统计学数据。对于2021年至2024年的患者，年龄中位数（IQR）为62（52 - 69）岁；4434名是女性（65.5%）；814名是黑人或非裔美国人（12.0%），121名是西班牙裔或拉丁裔（1.8%），5385名是白人（79.7%）。作为四药联合止吐方案一部分的奥氮平使用从2019年的7.2%增加到2024年的63.4%（χ21 = 553.61；P <.001）。
在这项关于符合条件患者奥氮平处方的质量改进研究中，MOQC采用质量改进方法，增加了奥氮平作为四药方案一部分在接受HEC患者中的处方量，远高于基线水平和全国处方率。这项工作表明，在全州协作中，改善患者护理的努力在不同类型、地点和规模的医疗实践中都可能有效。持续的努力包括支持处方率低的医疗实践做出改变，并证明这项工作对患者结局的重要性。
