Frontline oncology care team primary palliative symptom guideline education, the oncology care model, and emergency department visits.

Abstract

143 Background: The Oncology Care Model (OCM) is a novel 5-year quality-based Oncology payment and care delivery program established by the Centers for Medicare & Medicaid Service in 2016. OCM prioritizes high-quality, coordinated care for patients undergoing chemotherapy (chemo pts.) Participating centers provide augmented services to enhance care and meet quality goals. Challenging symptoms (sxs) are common among chemo pts and may lead to hospitalization and decreased quality of life. Specialist palliative care teams are not able to see all chemo pts with active sxs. Front line oncology care teams (FLC) need education on primary palliative sx management. Methods: Cleveland Clinic Taussig Cancer Institute is one of 181 practices voluntarily participating in OCM. Locations include main campus and 5 regional cancer offices with 100 oncologists caring for about 4,000 chemotherapy patients annually. Our OCM team engaged Oncology (Onc) and Palliative Medicine (PM) providers to standardize sx management. Education was provided to FLC of all disciplines. Electronic record analytics were used to determine emergency department (ED) utilization. Results: A multidisciplinary team of Onc and PM experts developed guidelines for 4 common sxs (chemotherapy-induced neuropathy, persistent cancer pain, nausea/vomiting and constipation. Guidelines were approved by key Onc and PM staff and made available to all providers online. There were 4 educational sessions for FLCs to all sites in 2017. Urgent sx outpatient appointment slots were created in oncology offices to address uncontrolled sx. From Dec 2017 to May 2018, ED visits for all cancer patients at main campus decreased from 500/month to 453/month (9.4%.) Reductions in ED visits were also seen at 2 hospitals adjacent to regional cancer centers (16% and 6%.) Conclusions: OCM participation provided an opportunity to improve care quality at our institution. Primary palliative sx guidelines were successfully developed by an interdisciplinary team and disseminated to FLC. Urgent sx management appointments were made available in oncology offices. These interventions coincided with a reduction in ED visits for all cancer patients.

Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model

“…With cancer care costs especially on the increase, the OCM, inclusive of a shared-savings component in a specialty with prescribing discretion over consequential high-cost care choices, represents a novel environment to evaluate these programs. This nonrandomized controlled study adds to the emerging literature by finding that first-year OCM participation was associated with lower office-based costs. However, consistent with prior research on similar programs, we also found that these savings were largely offset by the costs of these programs …”

“…A cross-sectional analysis by Parikh et al 16 found that oncologists participating in the OCM varied in their demographic characteristics, care intensity, and exposure to alternative models compared with nonparticipating oncologists in ways that practice-level analyses might meaningfully miss, motivating physician-level analysis. While there is some early suggestive evidence that the OCM altered hospitalization rates 17 and other descriptive or non-peer-reviewed work, 16,[18][19][20][21][22][23][24][25][26][27] there remain few assessments of the OCM's potential effects on care choices. 14 This study evaluates whether OCM participation was associated with clinician behavior within the context of their practices.…”