Do OCM-related increases in screening for depression and pain improve patient-reported symptoms?

Abstract

299 Background: Many patients with cancer experience pain and depression during treatment. Attention to these conditions may improve wellbeing and survival. The CMS Oncology Care Model (OCM) incorporated practice-reported quality measures related to screening and management of pain and depression. We assessed screening and management of pain and emotional problems among OCM-participating practices. Methods: We used data from two sources. First, we assessed changes through the first 5 years of OCM in two NQF-endorsed quality measures reported by OCM practices twice yearly: 1) Screening for Depression and Follow-Up Plan; and 2) Pain Assessment and Management. The measures reflected the proportion of OCM patients who were assessed and received a follow-up plan if indicated. Second, we surveyed Medicare fee-for-service patients who had OCM episodes quarterly (N=179,445 respondents; response rate=45%). The survey assessed whether patients experienced symptoms of pain or emotional problems, such as anxiety or depression, and whether their cancer team tried to help address those symptoms if present. For the patient survey measures, we estimated risk-adjusted trends in patient responses over time, from the baseline survey through the first 5 years of OCM. Results: Practice-reported findings: Practices began reporting quality measures in the second six-month performance period (PP) of OCM. Practice-reported rates of depression screening and follow-up plan increased from 57.2% in PP2 to 77.9% in PP9, a 20.7 percentage point improvement (p<0.05); rates for pain assessment and management improved from 77.6% in PP2 to 88.8% in PP8 (difference: +11.2 percentage points, p<0.05). Patient-reported findings: At OCM’s start, 49.9% of patients undergoing chemotherapy treatment at OCM practices reported they were bothered by emotional problems and 54.5% reported they were bothered by pain. Slightly fewer patients reported symptoms over time during OCM (quarterly time trend: -0.1% reporting symptoms, p<0.05 for both measures). Among patients reporting emotional problems at baseline, 44.2% reported that their care team “definitely” tried to help; there was no significant change over time. Among patients reporting pain at baseline, 75.3% reported that their care team “definitely” tried to help; slightly fewer respondents reported that their care team tried to help during OCM (quarterly time trend: -0.2%, p<0.05). Conclusions: Oncology practices participating in OCM reported substantial improvements in screening for pain and depression during OCM. However, patients’ experience with receiving care to address emotional needs and manage pain did not improve during OCM. Screening is an important first step for addressing pain and depression; additional efforts are needed to ensure that screening leads to meaningful improvements in symptom management.