An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Results from the beta model testing phase of a multisite initiative in the United States.

Authors

Matthew Smeltzer

Matthew Smeltzer

University of Memphis, School of Public Health, Memphis, TN

Matthew Smeltzer, Leigh Boehmer, Amanda Kramar, Thomas Asfeldt, Nicholas Faris, Christine Fay Amorosi, Meredith Ray, Vikki G. Nolan, Randall A. Oyer, Christopher S. Lathan, Raymond U. Osarogiagbon

Organizations

University of Memphis, School of Public Health, Memphis, TN, Association of Community Cancer Centers, Rockville, MD, Sanford Health, Sioux Falls, SD, Baptist Cancer Center, Memphis, TN, Health Quality Solutions, Arlington, VA, Ann B Barshinger Cancer Institute at Penn Medicine Lancaster General Health, Lancaster, PA, Dana-Farber Cancer Institute, Boston, MA, Multidisciplinary Thoracic Oncology Program, Memphis, TN

Research Funding

Other Foundation
Bristol Myers Squibb Foundation.

Background: Medicaid patients with lung cancer have poorer outcomes than non-Medicaid patients, partly because of suboptimal care quality. The Association of Community Cancer Centers (ACCC) launched a project to develop, test, and refine an OCCM. Methods: The OCCM comprised 13 areas, spanning care access to supportive care/survivorship. Using the OCCM, 7 cancer programs in 6 US states conducted self-assessments of care delivery systems and implemented quality improvement projects. Sites worked with ACCC to conduct data benchmarked projects. Data collection and analysis were centralized. Statistical analyses used Kruskal−Wallis and chi-squared tests. Results: There were 926 patients (257 Medicaid/dual eligible; 669 non-Medicaid) across 7 sites. Medicaid/dual eligible patients were 52% male, 69% Caucasian, 48% active smokers, and 45% clinical stage III/IV. Prospective multidisciplinary case planning (PMCP), patient care access, and tobacco cessation were commonly selected for projects. PMCP evaluation used fortnightly tumor board (FTB), virtual tumor board (VTB), and multidisciplinary team huddle (MTH). Presentation of eligible patients was higher for VTB and MTH (FTB: 23%, VTB: 100%, MTH: 100%, p < 0.0001). While FTB and MTH discussed all cases prospectively, VTB achieved 80%. Median days (d) from diagnosis to presentation were 18 (FTB), 14 (VTB), and 9 (MTH, p = 0.14). Patient care access was evaluated with timeliness metrics at 2 sites. Site 1: Medicaid patients had a median of 13 d from lesion discovery to diagnosis and 21 d from diagnosis to treatment (not different from non-Medicaid; p = 0.96 and 0.38). 94% met the goal of treatment initiation within 45 d. Site 2: Medicaid patients had a median of 16 d from discovery to diagnosis and 27 d from diagnosis to treatment (not different from non-Medicaid; p = 0.68 and 0.83). Similar benchmarks were collected and compared for other assessment areas. Sites identified enhanced collaboration and improved programming (e.g., patient navigation) as successes. Challenges at project start included inadequate staffing and lack of centralized data collection and benchmarking. Importance of lung cancer–dedicated navigation, PMCP, and Medicaid patient needs were key transferable lessons. Conclusions: The OCCM is useful for cancer programs’ self-assessment of care delivery to Medicaid patients across 13 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery, but sites may need additional resources to evaluate outcomes.

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Abstract Details

Meeting

2020 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

On-Demand Poster Session: Health Equity and Disparities

Track

Health Care Access, Equity, and Disparities

Sub Track

Access to Treatment and Supportive Care

Citation

J Clin Oncol 38, 2020 (suppl 29; abstr 105)

DOI

10.1200/JCO.2020.38.29_suppl.105

Abstract #

105

Poster Bd #

Online Only

Abstract Disclosures

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