Evaluating end-of-life (EOL) care at the University of Rochester Medical Center (URMC) using quality oncology practice initiative (QOPI) metrics.

Authors

null

Titas Banerjee

University of Rochester, Rochester, NY

Titas Banerjee, Jason Harold Mendler, Nabeel Badri, Dwight Hettler, Julie Ann Berkhof, Karen J. Abbas, Manidhar Reddy Lekkala, Bahar Moftakhar, Karim Welaya, Carissa Treptow, Dilip Sankar Babu, Megan Baumgart

Organizations

University of Rochester, Rochester, NY, Wilmot Cancer Ctr, Rochester, NY, University of Rochester Medical Center, Rochester, NY, Univ of Rochester Medcl Ctr, Rochester, NY

Research Funding

No funding received
None.

Background: Inpatient mortality, defined as death within 30 days of an acute hospital admission, is often used as a quality benchmark for healthcare institutions and is an important metric for evaluating quality of care of patients with advanced malignancies. In this study we aimed to utilize QOPI performance data to identify areas of weakness in our practice that may contribute to inpatient mortality. Methods: We analyzed 11 EOL measures within the QOPI database which we collected between 2015 and 2018. These included all EOL measures related to hospice enrollment (measure IDs 42-47), chemotherapy administered within the last 2 weeks of life (ID 48), percentage of patients who died from cancer with at least one emergency department (ED) visit in the last 30 days of life (ID 49ed), and the percentage of patients who died from cancer admitted to the Intensive Care Unit (ICU) in the last 30 days of life (ID 49icu). Our rate was calculated for each measure and compared against QOPI aggregate data. We used a fisher’s exact test to determine statistical significance for each metric. Results: The number of patients from our institution included in each analysis ranged from 27 to 46. Compared to our peers, patients treated at our institution were more likely to visit an ED in the last 30 days of life (68% vs. 32%; P < 0.0001), more likely to be admitted to the ICU in the last 30 days of life (29% vs. 9%; P = 0.0003), and more likely to be enrolled on hospice within the last 7 days of death (63% vs. 32%; P = 0.001). Conclusions: Analysis of QOPI EOL performance scores identified several metrics that may contribute to inpatient mortality at URMC. Ongoing participation in QOPI with a focus on EOL metrics will strengthen this analysis. We plan to use this data to guide quality improvement initiatives aimed at reducing impatient mortality and improving end of life care at our institution.

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Abstract Details

Meeting

2019 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cost, Value, and Policy; Health Equity and Disparities

Track

Cost, Value, and Policy,Health Care Access, Equity, and Disparities

Sub Track

Changing Landscape of Provider Organizations

Citation

J Clin Oncol 37, 2019 (suppl 27; abstr 12)

DOI

10.1200/JCO.2019.37.27_suppl.12

Abstract #

12

Poster Bd #

B7

Abstract Disclosures

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