Background: NorthShore University HealthSystem has created, via the Electronic Health Record (EHR), quarterly reports to measure quality of care for patients who die of cancer during the reporting time frame. Specific reports for 22 oncology providers and measurements across the population will be derived. Reports are automated with seamless data retrieval based on algorithms designed through the use of discrete, searchable entry fields. Goals include establishing a pre-report baseline, educating oncologists about their terminally ill patients’ outcomes and documenting improvements in end-of-life care through educational initiatives for patients and providers. Methods: To standardize reporting, a cohort of terminally ill patients was created based on QOPI definitions (Denominator). A set of quality end points to describe cancer utilization near the end of life was added as Numerator Values, to establish rates of potential inappropriate use of resources. Results: The OP, oncology EHR was changed to allow ADN/CSO placement that carry over to the IP EHR (hyperlink in patient header). The average time between a patient’s first OP, oncology visit and when the oncologist placed ADN/CSO will be calculated. ADN/CSO reports will be stratified by a patient’s age, race and oncologist. Each separate report will be validated prior to the “go live” phase. Conclusions: These metrics allow routine hypothesis generating queries of end-of-life care to assess compliance with quality measures.

Patients receiving chemotherapy: * IV in last 14 days of life * P.O. in last 30 days of life	General inpatient (IP) and/or ICU admissions in last 30 days of life: * # of admissions * Length Of Stay (LOS)	Outpatients (OP) with goals documented by oncologist: * Documented Code Status Order (CSO) * Advanced Directive Note (ADN)	Patients sent to emergency room (ED) after first oncology visit in 9-month period: * Weekday ED encounters * Weekend ED encounters	Patients with hospice enrollment within: * 3 days from death * 3–7 * >7 * Average time from CSO/ADN to hospice
Cohort of Interest: * QOPI predefined ICD9 diagnosis codes * Alive at beginning of reporting period * Died during reporting period * Two OP encounters with an oncologist during 9 months prior to death