QOPI® Fellowship Program Participation

Agenda Why Participate? ACGME and QOPI® Before the Round Chart Selection Criteria Round Dates After the Round

Why Participate? ACGME Teach Reports Prep for ‘Practice’ QOPI can serve as part of ACGME requirement for quality assessment and performance improvement activity Teach Importance of Quality Assessment and Improvement Important issues in care so that fellows do not miss them in the future (path on chart, informed consent, infertility risk, etc.) Prep for ‘Practice’ Expose fellows to quality assessment and improvement activities for transition to practice Practice where fellow goes may be QOPI participant or QOPI Certified Reports Scores on quality metrics to help inform QI project Comparative scores to other participating programs. Fellowship programs should participate in QOPI as it can serve as part of ACGME Common Program Requirements for Practice Based Learning and Improvement QA and PI activities. QOPI fulfills requirements by: applying quality indicators, peer review of charts and practice based improvement through chart review and follow up on QOPI data QOPI® teaches the importance of quality and performance improvement while bringing to mind the important issues of caring for oncology patients QOPI® prepares fellows for the quality and performance improvement activities that occur after graduating in practice. QOPI® reports show the fellowships how they score on quality metrics along with providing comparative scores

ACGME and QOPI Participation in QOPI helps fulfill the following ACGME requirements: Review and improve patient care through application of quality indicators. Apply current medical knowledge to patient care through selection, discussion and updating quality indicators. Use interpersonal and communication skills in peer review discussion. Assess and demonstrate professional ethical behavior, through peer review and concern for patients. Assess and demonstrate Awareness of systems-based practice as manifested by knowledge and development of quality indicators and application of uniform standards. Demonstrate practice-based improvement through initial chart review, review of QOPI data, improvement of challenging areas, and follow-up on QOPI data. ACGME Common Program Requirements (page 12 IV A.5.c) for Practice Based Learning and Improvement for Graduate Medical Education in Hematology and Oncology state: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. (Outcome) Residents are expected to develop skills and habits to be able to meet the following goals: IV.A.5.c).(1) identify strengths, deficiencies, and limits in one’s knowledge and expertise; (Outcome) IV.A.5.c).(2) set learning and improvement goals; (Outcome) IV.A.5.c).(3) identify and perform appropriate learning activities; (Outcome) IV.A.5.c).(4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (Outcome) IV.A.5.c).(5) incorporate formative evaluation feedback into daily practice; (Outcome) IV.A.5.c).(6) locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems; (Outcome) IV.A.5.c).(7) use information technology to optimize learning; and, (Outcome)  IV.A.5.c).(8) participate in the education of patients, families, students, residents and other health professionals. (Outcome) Additionally, under the Professionalism, Personal Responsibility and Patient Safety Regulations (VI.A.3), it states that: The program director must ensure that residents are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs. Participation in QOPI may help to fulfill the following ACGME requirements: Review and improve patient care through application of quality indicators. Apply current medical knowledge to patient care through selection, discussion and updating quality indicators. Use interpersonal and communication skills in peer review discussion. Assess and demonstrate professional ethical behavior, through peer review and concern for patients. Assess and demonstrate awareness of systems-based practice as manifested by knowledge and development of quality indicators and application of uniform standards. Demonstrate practice-based improvement through initial chart review, review of QOPI data, improvement of challenging areas, and follow-up on QOPI data.

Before the Round Designate a Lead Fellow to be responsible for participation and coordinate the efforts for the group. QOPI administrator may be the Lead Fellow, program director, or other program staff. Decide if Fellows will enter data together in one day, or over the course of the round. Ensure all Fellows who will enter chart data into the system have a username and password. The QOPI® ADMIN (lead fellow) and /or program director (PHC) can add users in the system now. The recommended number of charts per Fellow is 10. Some programs have found that having fellows abstract fewer than 10 charts is more feasible and does not compromise the value of their participation Fellowship programs should plan to participate at least once per year, during spring round. Designate a Lead Fellow to be responsible for participation and coordinate the efforts for the group. QOPI administrator may be the Lead Fellow, program director, or other program staff. Decide if Fellows will enter data together in one day, or over the course of the round. Ensure all Fellows who will enter chart data into the system have a username and password. The recommended number of charts per Fellow is 10. Some programs have found that having fellows abstract fewer than 10 charts is more feasible and does not compromise the value of their participation Fellowship programs should plan to participate at least once per year, during spring round.

Before the Round Time Pick Modules Pre-Screen Charts Decide how much time the trainees can set aside Plan a date on the calendar. Excuse the fellows from other activities. Time Ideally, pick an area that could be done at least two years in a row so that you can follow trends in care. If first time, consider EOL module. All programs also do Core measures. Pick Modules Fellows either prescreen “charts” him or herself or teach someone how to do this. Use QOPI Chart selection methodology Each prescreened case makes up a list. This list gets distributed to the fellows at the chart abstraction. Pre-Screen Charts Program Director and Lead Fellow: some more things you need to consider – above are recommendations from program directors that have participated in the past.

Before the Round Organize Information Get Trained Train Fellows Respond to questions – for fellowship program Information may need to come from Administration Returning practices need to update users (fellows) and practice/site information Organize Information QOPI Help Desk staff can walk you through the process. Review chart for modules selected – QOPI Help Desk staff can review with you, as needed FELLOWS: Review the chart submission training video in the current round documentation LEAD FELLOW/Program Direction: review the admin portal training video in the current round documentation Get Trained Build in a 20 to 30 min session in the fellowship programs didactic/ teaching sessions to review QOPI with the fellows before the fellows actually review the charts. This lecture gets the topic on everyone’s radar and prompts people to make sure that the data abstraction date is on their calendars. Train Fellows Program Director and Lead Fellow: some more things you need to consider - All the organization questions would be on fellowship program only (if you have a decided fellowship program account in QOPI) As a group, review the questions for the modules that will be selected to ensure that all fellows interpret the ‘questions’ the same. Prepare before the round opens, but also review, as a group, one chart per module selected using the web-based system once the round opens. This will ensure the group understands how to navigate the system, check the information submitted, and know how to correct chart errors or warnings. Use the QOPI help desk and available training slides to assist with orientation, process, and how to get started.

QOPI Round Offerings OR QOPI Certification Reporting Pathway Core Module Breast Cancer Colorectal Cancer GYNONC NHL NSCLC Symptom/Toxicity Management EOL Palliative Care Patient-Centered Oncology Practice PQRS Oncology Measures Group QOPI Certification Reporting Pathway OR Fellowship Programs (like QOPI® Participation) One module (disease or domain) plus core. (RECOMMENDED EOL OR Symptom/Tox Management) Test measures optional Abstract 10 charts per fellow. Programs are encouraged to choose additional modules as feasible to better assess care provided by the fellows. Fellowships participate in Spring abstraction typically. Fellowships can also choose the following in lieu of 1 module/core QOPI Certification Program (QCP) reporting pathway PQRS oncology measures group plus core Patient Centered Oncology Practice (PCOP) reporting pathway plus core. Module Selection: Fellowship Participation Guidelines Complete at least one module and Core questions to participate in the program. The OTP Subcommittee recommends the Symptom/Toxicity management module, but if it’s your first time participating then EOL is recommended. (covers more patients and more fellows) Modules in addition to EOL or symptom/toxicity management may be selected for internal review and analyses. \ QOPI® Participation One module (disease or domain) plus core. Practices are encouraged to choose additional modules, if possible, as feasible to better assess care provided by the practice. When you look at the target vs. qualify, a chart will qualify if it meets at least one measure with in the module. )This may be trouble for smaller practices but you will get better quality assessment) QOPI® Certification QOPI® Certification Pathway- abstract the 26 measures scored for Certification – **please note that fellowship programs cannot be certified** (Additional modules may be selected to report on all measures within the modules included in Certification, but it is not required. Breast cancer, Colon/Rectal Cancer, Non-Small Cell Lung Cancer, Symptom/Toxicity Management and Care at End of life (Core measures are included)

Fellows Fellow Requirements Determine abstraction process Have laptops and food ready Bring username and password Make sure each case has QOPI Chart ID number Email QOPI with questions regarding the data requested Don’t wait until the last day and ask for an extension Focus on quality of care and opportunities for improvement Fellows Determine with your Lead Fellow if your group will abstracting on one day or if you will be excused from clinical duties to abstract through the round

Round Dates Fellowship programs typically participated in the spring QOPI rounds (there is a fall and spring round each year) The spring round usually runs from mid-March to mid-May Contact the QOPI Help Desk for upcoming round dates

After the Round DISCUSS PRESENT REVIEW Review results with the fellows and faculty. Schedule a designated time for the review. DISCUSS There should be plenty of time for fun, interactive discussion of the results where ideas can be generated. “Yes, we do give chemo too often to patients near death” “We need better processes for informed consent” Etc. PRESENT Ideally, fellows will seize the opportunity to work Use the findings for process improvement Present his/her work at the ASCO Annual Meeting, Quality of Care Symposium, or other professional meetings. Remember that a limited sample of charts does not provide statistically reliable results, but may highlight areas to focus on for improvements

Correspondence Reminder Please do not send PHI. NO DATES NO PT NAMES ETC YOU CAN EMAIL WITH VAGUE TERMS/DATES BUT AVOID SPECIFICS THAT COULD TIE INFORMATION TO A PATIENT

Questions? Contact the QOPI Help Desk at QOPI@asco.org