Michigan Oncology Quality Consortium. Jeffrey Smerage, MD, PhD Physician Lead Jane Severson, RN, MHSA Project Manager

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1 Michigan Oncology Quality Consortium Jeffrey Smerage, MD, PhD Physician Lead Jane Severson, RN, MHSA Project Manager

2 I. MOQC Overview MOQC is the BCBSM coordinating center for practices participating in the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Started in Fall 2009 in response to the need for a systematic approach to quality improvement for Michigan QOPI practices University of Michigan manages the coordinating center

3 MOQC Participation 50 Practices Spring 2012

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5 What is QOPI? A practice based quality improvement program developed by ASCO that assesses medical oncology care processes Evidence, guideline and consensus based Measures are continually reviewed and updated by panel of experts currently over 100 measures Practices conduct statistically valid sampling every 6 months with reports available 1 month later Provides benchmarks with peers and national cohort as well as practice trends for self assessment 5

6 Core Measures Care Documentation Chemo Administration Pain Management Smoking Cessation Psychological Support Disease Specific Module Breast Cancer Colorectal Cancer Non Hodgkin s Lymphoma Non Small Cell Lung Cancer Domain Specific Module End of Life Care Symptom/Toxicity Management 6

7 Safe Chemotherapy Administration

8 MOQC QOPI CERTIFIED PRACTICES

9 COLLABORATIVE APPROACH

10 Multiple Mindsets Required for Clinical Change Improvement Leader Clinical Leader Focus: Change Focus: Effectiveness Processed focused Outcome focused Systems focusedmultiple inputs Risk taking & imagination Individual focused Evidence based practices Source: adapted from NHS Institute for Innovation & Improvement (2009)

11 Collaborative Learning Constructs Improvement by Understanding Your Own Performance A management process that fosters evaluation of how you do work today and how it could be done better in the future Improvement by Learning from Others Learning, sharing information and adopting best practices to bring about step changes in performance

12 Engaging Physicians in Setting Priorities

13 Adopted from: Langley GL, Nolan KM, Nolan TW, Norman CL, and Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass, Institute for Healthcare Improvement (IHI) web site, How to Improve,

14 PUTTING IT ALL TOGETHER: PALLIATIVE CARE DEMONSTRATION PROJECT

15 Palliative Care Demonstration Project Overview Aim: To improve the effectiveness and timely delivery of palliative care services in Michigan oncology practices To build practice leadership capability in quality improvement and change management Clinical Framework: Integrated Palliative Care Q I Model: Institute of Healthcare Improvement/ Lean Tools Measure: Select QOPI palliative care measures Change: Implement Edmonton Symptom Assessment System

16 MOQC Palliative Care Demonstration Project Participants

17 Framework: Integrated Palliative Care Disease Modifying Treatments Hospice Palliative Care Diagnosis Treatments to Relieve Suffering/Improve QOL 6Mo Death Bereavement

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21 MEASURE OF PERFORMANCE MOQC Palliative Care Dashboard

22 MOQC PALLIATIVE CARE DASHBOARD

23 CHANGE EDMONTON SYMPTOM ASSESSMENT SYSTEM

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25 Average ESAS Scores for 8 Demonstration Participants n= 730 ESAS forms / 8 practices

26 PERFORMANCE IMPROVEMENT PLAN 1. Check Current Performance 2.Determine WHY Issue 3. Establish Improvement Plan

27 ONE PRACTICE S SYMPTOM ANALYSIS: TIREDNESS 100% 90% 80% 70% Intervention 60% 50% 40% 30% >6 4 6 <4 20% 10% 0% Batch 1 n=37 Batch 2 n=34 Batch 3 n=34

28 Demonstration Preliminary Results: Fall 2011 vs. Spring % QOPI Pain Addressed: End of Life 100% QOPI Dyspnea Addressed: End of Life 90% 90% 80% Fall '11 80% Fall '11 70% Spring '12 70% Spring '12 60% 60% 50% PC Demo Other MOQC 50% PC Demo Other MOQC

29 High Performers Achieve More QOPI Hospice/ Palliative Care Referral 20% QOPI Chemo in Last 2 Weeks 100% 90% 15% Lower: Better 80% 70% Fall '11 Spring '12 10% Fall '11 Spring '12 60% 5% 50% PC Demo Other MOQC 0% PC Demo Other MOQC

30 MOQC Next Steps: Sustainability and Spread Implementation of ESAS in all interested MOQC practices to begin in August using a similar, yet modified approach over 6 months Staff educational forums on symptom assessment and management Goals of care planning demonstration project

31 FUTURE OPPORTUNITIES: IMPROVING SMOKING PERFORMANCE

32 Michigan QOPI Smoking Assessment Performance 100% 90% 80% 70% Smoking status/tobacco use documented in past year 60% 50% 40% 30% 20% 10% 0% Fall 2010 Spr 2011 Fall 2011 Spr 2012 Smoking/tobacco use cessation counseling recommended to smokers/tobacco users in past year Smoking/tobacco use cessation administered appropriately in the past year (Composite: defectfree) N=42 in Fall 2010, n=45 in Spring 2011, n=38 in Fall 2011, n=39 in Spring Source: QOPI data.

33 100 Smoking Cessation Counseling Rate Michigan vs. National QOPI Spring QOPI Site Michigan National N=32, excludes sites with less than 10 charts submitted. Source: QOPI Spring 2012 data.

34 Acknowledgements Douglas Blayney, MD Jeffrey Smerage, MD, PhD Jane Martin, MHSA Cameron Muir, MD Kevin DeHority Jane Severson, RN, MHSA Katherine Abstoss, MHSA Mahathy Kuchibhatla, MS