American Society for Radiation Oncology's Performance Assessment for the Advancement of Radiation Oncology Treatment: A practical approach for informing practice improvement.

Abstract

Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT) is a practice quality improvement program. This study seeks to determine baseline performance rates and practice variation from PAAROT data. The cohort includes all physicians from academic, hospital, and free-standing settings who completed at least 10 consecutive self-audited medical records in the PAAROT program (version 2.5) from 2010 to 2011 (n = 519 medical records). Mean performance rates were analyzed at the physician and medical record levels and, where appropriate, were stratified by the physician's practice setting. Forty-nine physicians were included in the study; 22 (45%), 17 (35%), and 10 (20%) physicians practiced in a hospital, academic, or a free-standing setting, respectively. The measures with a high adoption rate (more than 80%) include the following: documentation of history and physical; review of physics and dosimetry plan by radiation oncologist; patient informed risks of therapy; evaluation of acute symptoms during therapy; pathology in consultation note; communication of treatment summary within 30 days of treatment completion; documentation of intent of treatment, use of clinical guidelines or published data; and documentation of American Joint Committee on Cancer staging. Lower rates of adoption were noted (mean, 65%; range, 0-100%) when these measures were converted to a composite measure. Low adherence was noted for screening of a pain using a standard scale (mean, 58%; range, 0-100%). Physicians from an academic setting scored higher on the composite measure (40%) compared with those from a hospital setting (36%) and from a free-standing setting (24%); (P < .001). Physicians from a hospital setting scored higher on the quality indicator of screening for pain (54%) compared with physicians from an academic setting (35%) and free-standing setting (11%) (P < .001). This first assessment of PAAROT (version 2.5) data provides an initial snapshot on the use of quality indicators and practice patterns for radiation oncology. Self-reported practice data and the use of quality indicators will become important for the purpose of continuous, prospective evidence-based learning on an individual basis. Despite the small sample size, the data from this study will help address potential improvement opportunities for the next iteration of the PAAROT program.