Identifying areas for quality improvement through outpatient mortality review.

Authors

null

Denise Gococo-Benore

Mayo Clinic Florida, Jacksonville, FL

Denise Gococo-Benore, Adam McLain Kase, Umair Majeed, Muhamad Alhaj Moustafa, Ruqin Chen, Sree Battu, Molly Kilpatrick, Maisha Robinson, Jennifer Cowart, Alvaro Moreno-Aspitia, Jeremy Clifton Jones, Sikander Ailawadhi, Taimur Sher, Pooja Prem Advani

Organizations

Mayo Clinic Florida, Jacksonville, FL, Mayo Clinic, Rochester, MN, Division of Hematology & Medical Oncology, Mayo Clinic, Jacksonville, FL, Mayo Clinic, Jacksonville, FL

Research Funding

No funding received
None.

Background: Inpatient mortality review is commonly used to improve patient care. Individual review of outpatient deaths is less common, yet 30-day mortality after hospital stay is an important quality metric. In this study, we sought to identify opportunities for care improvement by reviewing outpatient mortalities for cancer patients who died within 30 days of hospitalization. Methods: We identified 48 patients at Mayo Clinic Florida, with a hematologic (heme) or solid tumor (onc) cancer, who died within 30 days of an index hospital stay in 2018. We created a 32-question review survey to address quality of care around the hospital stay. The review team consisted of 1) heme or onc attendings, 2) heme/onc fellows, and 3) palliative care attendings. Each case was reviewed by one member of each of the 3 groups, split into heme or onc cases. Discrepancies in objective data points were resolved by the research team. Results: Of 143 surveys sent to 13 physicians (3 heme), 112 responses from 11 physicians (1 heme) for 47 patients were received. Twenty-one patients (45%) received cancer therapy within 30 days of death, and 23 (49%) were admitted >2 times in 2 months prior to death. For onc cases, attendings rated prognosis as discussed 83% of the time, vs 65% of fellows and 39% of palliative care; in heme cases, the attending rated prognosis as discussed 11% of the time, vs 86% of fellows and 50% of palliative care. In heme cases, the attending rated expected survival <3 months in 33% of cases vs 71% by fellows and 89% by palliative care; in onc cases, the reviews were more consistent (79% attending, 85% fellow, 93% palliative care). See Table for timing of prognosis discussions and palliative care involvement. Conclusions: The most common improvement opportunities identified by reviewing heme/onc patients who died within 30 days of a hospital stay included documented prognosis discussion and involvement of palliative care. Opportunities differed between heme and onc patients. Future directions include identifying and mitigating barriers that providers face in reaching these goals for their patients.

Total (n=47)Hematology (n=18)Oncology (n=29)
Prognosis discussed at initial consultation30 (0.64)12 (0.67)18 (0.62)
Prognosis discussed at admission to the hospital21 (0.45)5 (0.28)16 (0.55)
Palliative care involved during hospitalization28 (0.60)8 (0.44)20 ( 0.69)
Palliative care involved in 30 days prior to death31 (0.66)9 (0.50)22 (0.76)

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Abstract Details

Meeting

2020 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

On-Demand Poster Session: Quality, Safety, and Implementation Science

Track

Quality, Safety, and Implementation Science

Sub Track

Quality Improvement Research and Implementation Science

Citation

J Clin Oncol 38, 2020 (suppl 29; abstr 230)

DOI

10.1200/JCO.2020.38.29_suppl.230

Abstract #

230

Poster Bd #

Online Only

Abstract Disclosures

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