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Measuring baseline adherence to Choosing Wisely recommendations in regional oncology clinics: Challenges and strategies.

133 Background: ASCO launched the Choosing Wisely campaign to reduce the use of interventions lacking evidence of benefit to cancer patients, but implementation may be a challenge. This project develops a stakeholder-informed process to prioritize and implement the 2012 ASCO Choosing Wisely (CW) recommendations in oncology clinic settings.


METHODS
Medical directors from 6 network-affiliated oncology clinics in the Puget Sound region selected 2 CW measures for implementation: (1) No biomarkers/advanced imaging following early breast cancer treated for cure, and; (2) No colony stimulating factor use for low FN risk chemotherapy.


RESULTS
Adherence is measured with data from each clinic's tumor registry, billing records, lab results, pathology reports, and clinic notes. Challenges to measuring baseline adherence included translating non-specific guidelines into discrete data elements (e.g. when does surveillance start?) or required measuring the absence of something, presenting quality control challenges to distinguish between adherence and missing data. Additional challenges are shown in the Table. To address these challenges, the team developed these strategies: (1) creation of specific data elements, (2) mapping clinics separately to the criteria and (3) employing methods such as Natural Language Processing to efficiently collect data from EMR.


CONCLUSIONS
It is feasible to measure adherence to ASCO CW recommendations with data sources available at oncology clinics. Variability in data platforms among clinics is inherent to the current medical landscape and must be accounted for in successful implementation of cross-clinic programs. [Table: see text].