Practice Application

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* Practice/Institution Name

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* Complete Address

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* Project Applicant Contact Information:

Applicants will be evaluated based on pertinent information about the practice/institution and the patient population served by the practice, as well as, leadership support.  Please answer the following questions for your oncology program.

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* Please describe your patient demographics and diversity.

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* Number & percentage of insured patients currently under care

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* Number & percentage of uninsured patients currently under care

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* Number & percentage of patients on Medicaid currently under care

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* Percentage of patient population who are of underserved population including: Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders

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* Percentage of patient population who are socioeconomically disadvantaged

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* Percentage of patient population who are underserved rural population

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* Percentage of patient population who are sexual and gender minorities, including LGBTQ+

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* Number of oncologists at the practice

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* Number of oncology-trained nurses at the practice

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* Number of oncology-trained NPs and PAs at practice

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* Number of new oncology cases per year

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* Total number of oncology patients seen per year

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* What is the approach to charity care at your practice/institution?

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* What is the approach to closing the gap in cancer care disparities at your practice/institution?

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* Is your practice part of a Critical Access Hospital (CAH), Rural Referral Center (RRC), Sole Community Hospital (SCH), Medicare-Dependent Hospital (MDH) or Disproportionate Share Hospital (DSH)? If yes, please indicate which below:

Participating practices/institutions must be willing to commit time and resources throughout the duration of the project.  Participants will be required to:

  • Assemble a core qualified team (four members) to lead the quality improvement efforts and attend the three in-person QTP meetings over a six-month period. One team member must be a physician and ASCO member; others may be clinical or administrative staff, and a patient, caregiver, and/or advocate representative.
  • Devote 8-10 hours of preparatory time before the first QTP session, including required reading
  • Attend and actively participate in all in-person education sessions
  • Select and lead a QI project at their clinical site during the program (a successful project will require at least two hours per week, including regular project team meetings and one to two webinars per month with coaches)
  • Assemble a team of abstractors for QOPI® quality measurement abstraction (may be different
    than the core team, such as a registrar, fellows, or nurses)
  • Abstraction team: Devote, over a six-month period, approximately one hour per chart, with a minimum of 30 charts
  • Meet with their project sponsors/institutional leadership semi-annually to advise of progress
  • Assist in organizing a QTP one-day workshop at the practice site.
     

    Team: Include four individuals per practice/institution. One team member must be a physician and ASCO member; others may be physicians, clinical or administrative staff. Teams may represent any oncology specialty. 


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* Physician/ASCO Member

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* Team Member #2

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* Team Member #3

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* Team Member #4

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* Please confirm that you are currently registered for, or previously participated in, ASCO’s Quality Oncology Practice Initiative (QOPI®)?

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* Which brand of EHR do you use?

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* Are there any other quality improvement initiatives currently underway at your practice? If so, please describe

Will team members be available to participate in one of the 2020 in-person Quality Training Program courses on the dates specified below? 

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* Course 1: January 16-17, March 19-20, and June 26

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* Course 2: Mid-July (2 days), Late September (2 days), and early December (1 day)

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* One Day Workshop Host: Will team members and institution be willing to participate in and host a one-day workshop of the Quality Training Program at their home institution in year 2 or 3? 

It is crucial that sponsoring practices/institutions support team members’ participation in the program. This includes commitment of leadership to the improvement project(s) and willingness to dedicate resources and protect participants’ time.  To demonstrate this commitment, please send a letter of support from institutional leadership to qualitytraining@asco.org
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