Building Consensus on Priorities for Improving Oncology Quality Measurement

PQA released today an important report that we believe is a key step towards improving the quality of care for individuals using oral anticancer medications (OAM). 

Working with our staff, 23 national oncology experts and patients have concluded that PQA’s top measurement priority should be a health plan performance measure to assess the degree to which patients take their OAMs as prescribed. 

PQA will begin research in 2024 to advance the health plan measure concept for adherence or persistence to OAMs. We’re excited to move forward with that in the coming months, but today I want to share some insights on our process and what you’ll find in the report: “Recommendations to Improve the Quality of Oral Anticancer Medication Use: A report from the PQA Quality Innovation and Research Initiative for Oncology.” 

A Consensus-Based Approach 

PQA’s multi-stakeholder, consensus-based approach is central to our mission and core to our measure development process. Through three workshops, the stakeholders we convened reached consensus on important gaps in quality of care, where a positive impact can be made through quality measurement.  

Perhaps most important, their decisions were guided by what is most likely to be scientifically acceptable, feasible and usable. These criteria are critical for identifying and vetting measure concepts that can be successfully developed and effectively used in real-world settings. 

We all have a vision of how we would like the world to be, but our consensus is based on what’s realistic, given the nature of our current health care system and the data available to evaluate care. 

Key Insights About OAM Quality Measurement 

Within our 30-page report, you’ll find details about our conclusions and how they were reached. Here are four notable points that I want to highlight:  

  • There is currently a lack of relevant OAM-related quality measures for health plan and pharmacy performance assessment. Many of the existing quality measures are process measures specified for clinician-level performance assessment. PQA can address this important gap in measurement by focusing on health plan and pharmacy measure opportunities. 
  • The uniqueness of OAMs and their use presents distinct challenges in defining and measuring adherence or persistence. That’s why our next step is to embark on research projects to explore various methodological approaches designed to inform subsequent measure development opportunities. The PQA Quality Innovation and Research Center (QuIRC) is ideal for answering the methodology questions needed to advance the prioritized health plan measure concept for adherence or persistence to OAMs. 
  • Our work found – not surprisingly – that dosing errors, toxicity, and drug interactions are major quality issues and challenges to high-quality care. These issues, in part, can be mitigated by comprehensive medication review programs and pharmacist-driven medication therapy management (MTM) services. These are important checkpoints in identifying and addressing medication therapy problems. This is one reason PQA is convening our members and stakeholders this November to advance MTM quality measurement. 
  • Our workshop participants concluded that it could be useful to develop a time-to-treatment measure to advance the quality of OAM use attributable to the pharmacy. However, the aspect of time-to-treatment not already captured in PQA’s Specialty Pharmacy Turnaround Time measure and the Specialty Pharmacy Prescription Abandonment Rate measure in-development is largely outside of the pharmacy’s control. We encourage stakeholders to use or pilot these measures and PQA will continue to assess the degree to which existing and in-development pharmacy measures meet the needs to assess timely access to OAMs.  

We look forward to your feedback on our report.  

I want to thank our members, staff and stakeholders who made this work possible, particularly the seven organizations who provided generous financial support: Boehringer Ingelheim, EMD Serono, Hematology/Oncology Pharmacy Association, Jazz Pharmaceuticals, Johnson & Johnson, Novartis and Pfizer.  

We need your continued support and participation as the next phase of this initiative begins. This work is led by our QuIRC team, and you can contact us at [email protected] 

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