Feasibility of assessing quality in medical oncology practices

PURPOSE This study was designed to test the feasibility of conducting routi ne quality assessment within Community, medical oncology practices. DESCRIPTION OF STUDY: Eleven medical oncologists practicing within the Fox Chase Network were surveyed over an 8-month period, using a standardized 10 -item checklist. Eight of the items (ie, board certification, continuing ed ucation, office procedure manual for chemotherapy, chemotherapy flow sheets , body surface area calculations, adherence to guidelines for follow-up of breast cancer, adjuvant hormones in women with estrogen receptor-positive b reast cancer, and patient satisfaction survey) were chosen because they mea sure Structural and process variables particularly relevant to die high-vol ume clinical services seen in private practice oncology. The authors also c alculated two rates (protocol accrual and neutropenic complications of chem otherapy) to test as putative indicators of quality. RESULTS: The authors found a high level of both physician interest in devel oping the audit measures and compliance with the survey process. Overall qu ality of care, as measured by structure and process variables, was excellen t with negligible internal variability Derived rates of protocol accrual (0 .003-0.373; mean 0.11, SD 0.11) and neutropenic sepsis (0.004-0.014; mean 0 .007, SD 0.004) show considerable variability, however, and are only minima lly correlated (r = -.36). These are both potential indicators of quality t hat should be further evaluated. CLINICAL IMPLICATIONS: The authors have demonstrated the feasibility of con ducting quality assessment within private medical oncology practices and ha ve identified two easily calculated rates that merit further study as poten tial indicators of quality.