The impetus for founding the Quality Oncology Practice Initiative (QOPI) arose from the convergence of three experiences. First, I am a pediatric oncologist. The practice model of pediatric oncology differs greatly from that of most adult cancer therapy in several respects: Concurrent multidisciplinary care is routinely provided; a physician navigator provides longitudinal medical direction for the patient and family; most patients participate in clinical trials that require prior peer-reviewed planning of therapy and a structured review of outcomes; and because most pediatric oncologists are employed at children's hospitals or cancer centers, fees for technology, procedures, chemotherapy, and laboratory work are retained by the institutions, removing potential conflicts of interest from medical recommendations. I believe this is a superior model of cancer care because it inherently promotes quality care.

Second, I served on the National Cancer Policy Board of the Institute of Medicine (IOM) from 1996 to 2005. The major work of the board was to issue rigorously peer-reviewed reports that included recommendations with the potential to aid or influence policy makers. Several of those reports concerned the quality of cancer care, such as Ensuring Quality Cancer Care¹ in 1999 and Enhancing Data Systems to Improve the Quality of Cancer Care² in 2000. Participation in this series ofanalyses provided an understanding of the robust literature describing the wide variability of the quality of cancer care in the United States.

Third, during my term at the IOM, the Bush administration was preparing legislation that would ultimately be passed by Congress on December 8, 2003, as the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.³ In the 2 years preceding passage of the bill, the medical oncology community was in an uproar. Because Medicare funds exist in two separate categories (ie, prescription drugs and everything else), in order to provide a costly additional pharmaceutical benefit to seniors, the money had to come out of the prescription drug pot. Because many of the most expensive drugs were prescribed by oncologists, Congress planned to change the formula for reimbursing oncologists and other medical specialists for the purchase, resale, and administration of drugs to patients, which would have reduced physicians' income. ASCO was heavily involved in the attempt to modify the bill, which involved many trips to Capitol Hill. These activities consumed a great deal of ASCO's energy, leading some members to reflect on the propriety of these efforts and to fear that ASCO was becoming known more for its interest in personal income than in patient care and education. Others asked, “Where is the patient in all of this?”

In response to these concerns as well as to the IOM reports, ASCO formed the Quality Working Group, of which I was a member. The group grappled with what to do, but it was unable to shape a viable quality plan. After much whining and agitation on my part, ASCO asked me to develop a proposal to be presented to the ASCO Board of Directors at its November 2002 meeting. I formed a steering committee that included Peter Eisenberg, MD, Monica Morrow, MD, Thomas Smith, MD, Philip Stella, MD, Ellen Stovall, Rodger Winn, MD, Robert Young, MD, and George Browman, MD. On September 10, 2002, we sent the board a draft proposal, which included the background, rationale, and specific characteristics of a new approach. The vision of the initiative was and is: ASCO becomes the international leader in promoting high-quality cancer care. The mission: to develop and promote a practical program for promoting excellence in cancer care that first, can be used anywhere; second, measures progress; and third, rewards successful participants in the program. The final version was delivered to the board in November 2002, and after some hesitancy, the board approved the initial effort. The bedrock principles we established were that this voluntary program and its data would be run and managed by the participating physicians; de-identified data would be collected by practices and submitted to ASCO for data management; the results would be returned to participating practices, showing their performance compared with other practices; no money would be taken from the pharmaceutical industry; and ASCO would provide some support, but most of the work would be done by volunteers.

In early 2003, I approached friends about medical oncology practices interested in quality-of-care issues to test the model. I initially asked seven practices to participate, and they all accepted. The practice champions in this alpha group were Peter Eisenberg, MD, Christopher Desch, MD, Dean Gesme, MD, Mike Neuss, MD, Mohammad Jahanzeb, MD, Joseph Jacobson, MD, and John Rainey, MD. After trial runs, a beta group was enlisted that included Albert Casazza, MD, Kevin Knopf, MD, Denis Hammond, MD, Russell Hoverman, MD, PhD, John Keech, DO, Richard McGee, MD, Therese Mulvey, MD, and Judy Schmidt, MD. This was followed by the gamma group, the third and final pilot group, which included Richard Levine, MD, Jacob Frick, MD, Gilberto Rodrigues, MD, Bohdan Halibey, MD, Roscoe Morton, MD, Barbara McAneny, MD, Kent Adler, MD, and John Cox, DO.

These 25 practices composing the three pilot groups, along with Kristen McNiff, MPH, at ASCO, did all the spade work in preparing QOPI to be opened to any ASCO member in 2006. QOPI now has 500 participating practices that report data on approximately 35,000 medical records annually. Kudos to all participants for making QOPI a force in promoting quality cancer care.

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