Meaningful measures for advanced cancer: Building a measure set to promote goal-concordant care.

Authors

Kristen McNiff Landrum

Kristen K. McNiff Landrum

KM Healthcare Consulting, Atlanta, GA

Kristen K. McNiff Landrum, Tom Ross, Corinna Andiel, Keith D. Eaton, Stephen B. Edge, Marina C. George, Joshua Lakin, Denise Morse, Joseph Papio, Wendy Plank, Lauren Thacker, Emily Thompson, Finly Zachariah, Jack Kolosky

Organizations

KM Healthcare Consulting, Atlanta, GA, Ross Oncology Consulting, Tampa, FL, Memorial Sloan Kettering Cancer Center, New York, NY, University of Washington, Seattle, WA, Roswell Park Comprehensive Cancer Center, Buffalo, NY, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, Dana-Farber Cancer Institute, Boston, MA, City of Hope, Duarte, CA, The Ohio State University Wexner Medical Center, Columbus, OH, Moffitt Cancer Center, Tampa, FL, The Ohio State University James Cancer Center, Columbus, OH, MD Anderson Cancer Center, Houston, TX, Alliance of Dedicated Cancer Centers, Houston, TX

Research Funding

Other
Alliance of Dedicated Cancer Centers.

Background: Research suggests that patients with advanced cancer do not reliably receive care consistent with their goals and values, indicating an important gap. While experts promote measurement of ‘goal concordant care’ this construct is difficult to measure due to definitional and data complexity. The 10 cancer hospitals of the Alliance of Dedicated Cancer Centers (ADCC) have collaboratively implemented interventions to improve goal concordant care and create a wholistic measure set through the Improving Goal Concordant Care (IGCC) Initiative. Methods: ADCC launched the 3 year initiative in 2020. Oncology, palliative care and quality experts completed conceptual work prior to launch including identifying core intervention components, specific aims and potential measures. Following an environmental scan, a workgroup brainstormed relevant measures, then applied feasibility and priority ratings. Patient/family advisors provided guidance. In 2020, a measure panel initiated technical development, using existing specifications as feasible. Claims-based measures were modeled. Following alpha testing, quarterly data submission of selected measures began in 2022. Results: During the conceptual phase, the workgroup identified 60 measures. 19 measures remained following the prioritization and feasibility rating; 14 have been tested and implemented to date (Table). A stakeholder (e.g., patients, physicians, administrators) assessment regarding each measure’s value in assessing quality and usefulness for improvement is in progress. Conclusions: In support of IGCC, we created a set of measures to assess progress towards achieving goal-concordant care. This measure set is intended to be useful in any cancer setting.

IGCC measure set.

Domain
Brief Measure Title
Implementation Status
Training
% of eligible oncologists who:

· complete communications skills training

· report positive perceived value of training


· Quarterly submission ongoing


Provider Experience
% of eligible oncologists who:

· report increased self-efficacy in goals of care (GOC) conversations

· report distress
· Implementation in Q3 2022
EHR Documentation
% of patients with documentation of:

· GOC discussion

· palliative/supportive care referral in the last 12 months of life

· hospice referral in last 6 months of life

· health care proxy
· Quarterly submission ongoing


Utilization
Among deceased patients:

· total medical costs

· # admissions

· days admitted

· days at home

· location of death
· Claims specification and baseline analysis complete
Utilization (CMS)
% of deceased patients:

· chemotherapy in the last 14 days of life

· ICU in the last 30 days of life

· not admitted to hospice

· admitted to hospice for < 3 days


· Claims baseline analysis complete
Outcomes
% of patients who:

· feel “Heard & Understood” (AAHPM)

· receive care consistent with goals
· Survey integration underway

· Specification in process; 2023 implementation

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Palliative Care

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 210)

DOI

10.1200/JCO.2022.40.28_suppl.210

Abstract #

210

Poster Bd #

B7

Abstract Disclosures

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