The Quality Training Program prepares teams of oncology providers to design, implement, and lead successful quality improvement activities in their practice settings. The 6-month training program includes a structured and facilitated improvement project that is selected by each oncology team in order to solve a problem in their own clinical setting with guidance from experienced coaches.
“The Quality Training Program gives you multiple tools not only for data analysis and collection, but also for leadership skills,” said Pelin Cinar, MD, MS, of Stanford University Cancer Center, who participated in the 2015–2016 Quality Training Program class. “Each session contained one or two talks on team building and management. My team came out of the program with not only the tools to pursue quality initiatives at our institution, but also the tools needed to become leaders in quality and in the field [of oncology].”
How the Quality Training Program Works
Quality Training Program teams participate in three in-person learning sessions divided into four phases: pre-work, planning, implementation, and sustain and spread. During the 2-month pre-work phase, team members complete pre-assessments, knowledge surveys, and other pre-work activities.
Teams refine the goals of their project, develop a process map, collect diagnostic and baseline data at their institution, and select measures of performance during the planning phase of the program. In the third phase of the program, teams develop their project action plan, conduct at least one test of change, collect performance data, create a plan for sustainability, and prepare for a final presentation to their Quality Training Program peers.
The fourth and final phase of the program involves sustaining and expanding practice changes that result in measurable quality improvements.
2015–2016 Class Projects
The 2015–2016 Quality Training Program class included teams from the University of Virginia, Stanford University, and Our Lady of the Lake Physician Group.
University of Virginia
The University of Virginia team, led by Tri Minh Le, MD, worked on optimizing the identification and treatment of patients with febrile neutropenia. Fever is a complication that occurs frequently in patients with chemotherapy-induced neutropenia. The mortality rate associated with untreated bacterial infections in these patients is high. To address this, the team’s goal was to decrease the time to less than 1 hour between a new episode of febrile neutropenia and the administration of appropriate antibiotics.
“The project was a big undertaking,” Dr. Le said. “We felt the Quality Training Program provided us with an opportunity to participate in an educational program developed by oncologists and oncology care specialists specifically for teams such as ours. We sought to expand our knowledge of quality improvement techniques. At the beginning of our project, our team was not yet familiar with a structured approach to quality improvement in oncology and felt that this program was well designed to help us meet our goals.”
Dr. Cinar and the Stanford University team wanted their Quality Training Program project to reduce intensive care unit (ICU) deaths of patients with advanced cancers by 25%. Dr. Cinar, a gastrointestinal cancers specialist, sees many patients with advanced solid tumors enter the ICU at the end of life.
“We think there is a more dignified way for patients to pass away,” Dr. Cinar said. “We need to focus on symptom management and supportive care, as well as the quality of life at the end of the life.”
The Stanford University team reported that 65% of the patients did not receive a consultation with a palliative care service until the last week of life. This late intervention was identified as a missed opportunity for patients with advanced cancer because symptom management contributes to improvement in quality of life.
Through their project, they developed criteria for the ICU team to communicate with primary oncologists and trigger early referral to palliative care shortly after the patients are admitted to the ICU. The criteria included all patients with stage IV disease and patients with stage III lung or pancreatic cancer, in addition to one or more of the following: two plus lines of prior chemotherapy with a life expectancy of less than 6 months or refractory disease, hospitalization within prior 30 days, more than 7 days of hospitalization, and uncontrolled symptoms. ICU trainees were to call the primary oncologists and discuss the role of palliative care consultation for patients who met the criteria. Results of their findings (Abstract 234) will be presented during the ASCO Quality Care Symposium, Poster Session B: Science of Quality, on Saturday, February 27.
Our Lady of the Lake Physician Group
The Our Lady of the Lake Physician Group team, led by Lauren A. Zatarain, MD, worked to implement a dedicated chemotherapy patient-education process.
“Participation in the Quality Training Program allowed us to specifically identify our clinic’s individual barriers to implementing these new processes,” she explained. “As an example, we realized that there was no written consent form in place when patients initiated oral oncolytics. We recently completed a review of our baseline data, demonstrating that only 22% of patients signed a written consent form when initiated on oral oncology medications.”
Dr. Zatarain and colleagues have implemented several new strategies, including reminder checklists for providers, to improve the consenting process. As of October 2015, the project met its goal of 75% of patients having signed written consent forms.
A Lasting Impression
Drs. Le, Cinar, and Zatarain recommend the Quality Training Program to oncology practices and institutions for a variety of reasons, including its structured deadlines and collaborative atmosphere.
“Our experience with the Quality Training Program has been extremely educational and enjoyable,” Dr. Le said. “We have learned a substantial amount of quality-improvement strategies that have helped us organize our project, from using data tools to track our progress to prioritizing our interventions to reach our project goals.”
More information on the Quality Training Program, including participation requirements, is available online.