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Defining Quality and Implementing a Quality Program in a Large Institution

Defining Quality and Implementing a Quality Program in a Large Institution. Brian Hunis, MD Thoracic and Head & Neck Oncology Director, Quality Initiatives Memorial Cancer Institute Hollywood, FL. No financial disclosures. Overview. What is Quality Why does it matter

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Defining Quality and Implementing a Quality Program in a Large Institution

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  1. Defining Quality and Implementing a Quality Program in a Large Institution Brian Hunis, MD Thoracic and Head & Neck Oncology Director, Quality Initiatives Memorial Cancer Institute Hollywood, FL

  2. No financial disclosures

  3. Overview • What is Quality • Why does it matter • Implementing a quality program at a large institution

  4. Quality?

  5. Defining Quality • The Institute of Medicine: the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making.

  6. Generally in reference to very specific clinical data collected and analyzed over a period of time. • Different agencies and groups have different ways of reporting clinical outcomes that can affect the way they rate a hospital or practice on a certain quality measure. • Reporting systems can also be cumbersome or costly, making ratings even more difficult to produce.

  7. Does it really matter? VS

  8. The word Cancer is “only” present 47 times in 906 pages… Quality is present 563 times…

  9. :Implementing a quality program at a large institution • Memorial Healthcare System. Third-largest public health care system in the nation. • System-wide culture of quality care. • Dedicated Chief Quality officer (an MD)

  10. Memorial Cancer Institute, Hollywood FL • 5 sites. South Broward County and North Miami-Dade • Comprehensive community oncology practice • BMT program, including Allo’s • Dedicated Breast Oncology Centers • 26 MD’s. Age range mid 30’s to mid to late 60’s • Multidisciplinary approach • Strong support services, navigator program & palliative care

  11. Successful quality program • Designed and run by oncologists • Relevant, valuable and transparent • Clear measurements that allows comparison with peers • Simple, inexpensive • Dynamic, able to modify “on the run”

  12. QOPI • Oncologist-led, practice based voluntary quality improvement initiative • Goal: to promote excellence in cancer care by helping oncology practices create a culture of self-examination and improvement • Over 500 practices have participated, 200 certified practices (as of 4/2014). 9 in Florida.

  13. Culture “shift” • Focus on processes • Physician engagement – actionable data

  14. Individual physician-level change • Practice-level change • System-level change

  15. What does the data show? • High variability in the quality of cancer care • Significant improvement in some measures, while others not so much after participation in data abstraction • Smoking cessation and Infertility counseling • “Perfection may not be possible or desirable and also demonstrates a known impediment to guideline adherence” • Neus et al, J Clin Oncol 31:1471-1477, 2013

  16. Florida initiative for quality cancer care (FIQCC) • 11 practices state wide. Academic and non-academic • established in 2004 with the overall goal of evaluating and improving the quality of cancer care at the regional level in Florida

  17. FIQCC • 35 colorectal cancer quality indicators. • Improvement in adherence to quality indicators were observed during a 3-year interval (2006-2009), however adherence remained low for several other indicators. Siegel et al, j.jamcollsurg.2013.09.008

  18. Perineural Invasion >12 LN’s Documentation of planned chemotherapy regimen Informed consent treatment with approved chemotherapy regimens

  19. In summary… • Quality measurements alone does not reliable result in quality improvement. • “quality” knowledge and skills development ( ASCO quality training program) • Payment reform ( Accountable care act, Michigan Oncology Quality consortium )

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