Radiation Oncology Corner
Meet Matthew B. Spraker, MD, PhD, Chief Resident in radiation oncology at the University of Washington School of Medicine, and the current recipient of the E. Stephen Amis, Jr., MD, Fellowship in Quality and Safety
Tell me about yourself.
I grew up in Chicago and completed all of my medical training there. After college, I earned a doctorate degree in bioengineering, and then went to medical school and did an intern year at the University of Illinois at Chicago. I matched for radiation oncology residency and was fortunate to end up at the University of Washington (UW) in Seattle. I’ve found that training there has been a great experience.
How did you get involved with patient safety and quality improvement (QI)?
The residents at UW are exposed to patient safety and QI concepts frequently throughout residency. We have a strong safety culture in our clinic with high volume incident reporting and an active patient safety and QI research group. The residents also frequently participate in safety and QI activities outside the department, such as the university-wide House Staff Quality and Safety Committee. As these opportunities came up, I grew more involved with patient safety and QI.
Why is patient safety and QI important in radiation oncology?
There are a couple of reasons. Modern radiation oncologists have all these great tools to treat their patients. However, these modern tools, like stereotactic radiosurgery, are actually very complicated systems of specialized care providers and workflows. There is a lot of room for error. It is important that radiation oncologists not only need to pick the right treatment for the right patient, but also ensure that treatment is delivered safely as intended. This is being increasingly recognized in our health care system. The Medicare Access and CHIP Reauthorization Act of 2015 will tie quality indicators to reimbursement.
I also believe the quality of cancer care represents an important target for improving outcomes in radiation oncology. For example, a recent study indicated that increased delay in starting definitive chemoradiation therapy for non-small cell lung cancer was associated with worse survival. If we better understand the complex factors that increase delays in starting treatment, we might be able to intervene. It’s like the next generation of personalized treatment- focusing not only on tumor biology, but patient context, such as whether they have social support, comorbid medical conditions, education level, economic status, etc.
The first week of the Amis Fellowship involves visiting the ACR headquarters for a week. What was the visit like?
I flew down to ACR’s headquarters in Reston, Va., to visit for a week. I first went on an accreditation site visit to a radiation oncology clinic. It was fun to see other radiation oncologists’ radiotherapy work flows and how they approach quality and safety in their clinic. Otherwise, I spent most of the week meeting with people that work on ACR’s broad efforts. I was so surprised at how many innovative initiatives they are undertaking to address the safety and quality of patient care. Their IT efforts on behalf of radiologists are probably the most interesting thing. They are working with vendors to incorporate decision support modules into the electronic health record. They also offer software to radiologists so they can peer review their partner’s reads.
A lot of these projects were more radiology-focused, but everyone loved to discuss ideas for expanding radiation oncology efforts. Overall, everyone was very hospitable! Radiation oncology residents should be applying for this fellowship every year.
That sounds great! What is the next step in radiation oncology safety and quality research?
The concept of big data research is in danger of becoming cliché, but I think this is the future in radiation oncology safety and QI research. The great thing about being a trainee now is that we practice in a digital world where everything can be recorded and analyzed. Radiation oncologists generate so much data with clinical assessments, delineation of targets and at-risk structures, and standardized toxicity reporting. There is a similar thing going on with patients. They carry around hand-held computers and sensors all day, and they are already collecting and sharing unprecedented amounts of data about themselves and the context in which they live (and will be treated).
So we have all this information about the way we practice and the way the patients live, and with that you can take a sophisticated look at safety and quality in our practices. The next step will be creating tools for radiation oncologists and other providers to efficiently visualize all this data and incorporate it into practice an intelligent way. It’s a big next step, but it’s doable.
By Meghan Macomber, MD, MS, ACR RFS Radiation Oncology Resident Chair, Chief Resident and Radiation Oncology Resident at UW School of Medicine