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Limitations of QOPI end-of-life (EOL) data use for purposes of accountability: Comparison of sample versus full cohort analysis.

87 Background: Quality Oncology Practice Initiative (QOPI) retrospectively collects process measures at the practice level. Sample size is determined by number of full-time equivalent physicians. Although intended as an improvement program, there is growing pressure to use QOPI for accountability.


METHODS
We investigated QOPI sampling strategy for EOL measures in a large three-site community oncology practice for all patients meeting QOPI sampling criteria. Analysis period was July 1 to December 31, 2012. We included all patients submitted for the QOPI EOL module and compared the QOPI sample to the full but non-QOPI cohort using Fisher's exact test. To assess relative precision, we calculated rates and 95% confidence intervals (CI) for the sampled vs. full cohorts (inclusive of QOPI cohort).


RESULTS
246 deaths were analyzed, with 34 (13.8%) from the QOPI sample. No statistically significant differences were found between sampled and full non-QOPI cohorts. However, sampling was associated with wide CIs compared to precision using the full cohort (Table); e.g. #38 yields a CI width of 24.2% QOPI vs. 4.9% full. Similarly, #47 shows CI width of 27.7% vs. 9.0%. Low statistical significance yet wide CIs indicate comparison data are representative but with variability in precision.


CONCLUSIONS
Although no statistically significant differences were identified, comparing QOPI sampling strategy to full cohort yielded presence of marked differences in precision. We suggest caution in use of current QOPI EOL sampling strategy if used for purposes other than improvement. [Table: see text].