Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

Authors

null

Brooke Worster

Thomas Jefferson University, Philadelphia, PA

Brooke Worster , Valerie P Csik , Jared Minetola , Gregory D. Garber , Alison Petok , Liana Yocavitch , Jasmine Tenpa Lama , Krupa Gandhi , Grace L. Lu-Yao

Organizations

Thomas Jefferson University, Philadelphia, PA, Sidney Kimmel Cancer Center, Philadelphia, PA, University of Pennsylvania Cancer Center, Philadelphia, PA, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA

Research Funding

Other

Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Health Services Research, Clinical Informatics, and Quality of Care

Track

Quality Care/Health Services Research

Sub Track

Care Delivery/Models of Care

Citation

J Clin Oncol 37, 2019 (suppl; abstr 6537)

DOI

10.1200/JCO.2019.37.15_suppl.6537

Abstract #

6537

Poster Bd #

228

Abstract Disclosures

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