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J Cancer Educ. 2015 Dec;30(4):774-8. doi: 10.1007/s13187-015-0798-z.

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

Zhu J1, Zhang T2,3, Shah R3,4, Kamal AH2,3, Kelley MJ5,6,7.

Author information

1
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
2
Duke Cancer Institute, Duke University, Durham, NC, USA.
3
Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
4
Hematology/Oncology, Durham VA Medical Center, 508 Fulton Street 111G, Durham, NC, 27705, USA.
5
Duke Cancer Institute, Duke University, Durham, NC, USA. michael.kelley@duke.edu.
6
Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. michael.kelley@duke.edu.
7
Hematology/Oncology, Durham VA Medical Center, 508 Fulton Street 111G, Durham, NC, 27705, USA. michael.kelley@duke.edu.

Abstract

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may be significant inter-observer variability.

KEYWORDS:

Advance practice providers; Attending physicians; Quality improvement; Training support

PMID:
25686787
DOI:
10.1007/s13187-015-0798-z
[Indexed for MEDLINE]

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