INNV-12. A QUALITY IMPROVEMENT PROGRAM FOR GLIOBLASTOMA PATIENT CARE QUALITY IN TWO ACADEMIC TERTIARY U.S. NEURO-ONCOLOGY CENTERS

Abstract

BACKGROUND: To address needs for quality improvement (QI) initiatives in glioblastoma (GBM) patient care, we are conducting a QI program in 2 major U.S. neuro-oncology centers. METHODS: At baseline, we retrospectively reviewed EMRs for 100 GBM patients (50 in each center), assessing physicians performance of quality-based and NCCN guidelinedirected biomarker testing and diagnostic procedures, time from diagnosis to tests/treatments, tumor board reviews, clinical trial enrollment, GBM treatments, and patient-centered measures. Multidisciplinary GBM teams in each center are participating in QI interventions including feedback on baseline EMR results and developing action plans for improvement. Postintervention EMRs will be retrospectively reviewed for 50 GBM patients in each center. RESULTS: At baseline, for 100 GBM patients diagnosed between 2012-17, median age was 63 years (26-89), median KPS was 80 (40-90), 22% were female, 82% were Caucasian, 72% were referred from community settings, and 17% were treated at a county hospital with chemotherapy or radiation. Percentages of biomarker tests included: MGMT, 61%; IDH1/2, 80%; 1p19q codeletion, 63%; EGFR, 65%; and TERT, 5%. Mean number of days from diagnosis to tests/treatments were: Postoperative MRI, 2.2; pathology report, 8.6; molecular test report, 8.1; initiation of chemotherapy, 27.7; and radiotherapy, 29.3. Tumor board reviews and clinical trial discussions were performed in 55% and 84% of patients, respectively. Percentages of patient-centered care practices included: interdisciplinary care coordination, 92%; discussion of prognosis, 79%; and timely hospice involvement for patients without treatment options, 40%. Higher incidence of selected biomarker tests performed was significantly associated with male sex, Caucasian race, higher KPS grade, and clinical trial discussion. CONCLUSIONS: The methods and findings from this QI program on GBM are relevant to designing scalable initiatives across community-based and academic neuro-oncology centers. Our presentation, which will include post-intervention results, will address practical applications for improving quality-based and guideline-directed practices for patients with GBM.