Choosing Wisely in oncology: Are we ready for value-based care?

275 Background: The Choosing Wisely (CW) Campaign challenges patients, healthcare providers, and specialty disease societies to make better decisions about healthcare delivery. In 2012, Schnipper et al. published ASCO's Top Five List targeting overuse of medications, tests, and procedures that are costly and lack evidence. 1.) Do not use cancer-directed therapy for patients with low performance status (undocumented, 3 or 4). 2.) Do not use PET, CT and radionuclide bone scans in the staging of early prostate cancer. 3.) Do not use PET, CT and radionuclide bone scans in the staging of early breast cancer. 4.) Blood tests for biomarkers and advanced imaging tests should not be used to screen for cancer recurrences in early breast cancer. 5.) Avoid administering colony stimulating factors (CSFs) to patients undergoing chemotherapy who have less than a 20 percent risk for febrile neutropenia. These recommendations are an opportunity to provide a tool to identify the gaps in care and enhance the value of care.

METHODS: We evaluated results from the ASCO Quality Oncology Practice Initiative (QOPI) CW "test" measures. We analyzed four QOPI collection periods for which measures were available to all participants (Spring '13, Fall '13, Spring '14, Spring '15).

RESULTS: 361 unique oncology practices (155, 160, 161, and 187 participants in the Spring '13, Fall '13, Spring '14, and Spring '15 cycles, respectively) collected data on CW measures within QOPI. Trends for performance varied for specific recommendations and marked variability was noted between practices in performance (range 0% to 100% adherent for any measure). Measure 2 was reported by only one practice in 3 out of the 4 cycles. Using linear regression, adherence decreased over time between rounds for measures 1 and 5 (-2.05; p<0.01 and 1.37; p=0.05), while adherence to measures 3 and 4 increased (0.26; p=0.60 and 2.63; p=0.04).

CONCLUSIONS: This is the first examination of cancer-related CW measures among oncology practices reporting their performance in QOPI. Although significant variability exists, concordance with CW guidelines remains low across the United States. Opportunity exists for further research into the causes of this low compliance and to share best practices.