Examining value-based care outcomes in gastric and esophageal patients with and without access to registered dietitians: A retrospective cohort study of patients enrolled in the oncology care model.

Abstract

264 Background: Patients with gastric and esophageal cancers are at high risk for malnutrition. Appropriate nutrition care provided by a registered dietitian (RD) as part of a multidisciplinary care team is supported by evidenced-based guidelines and clinical studies focused on surgical outcomes. However, Medicare does not routinely cover outpatient RD services for oncology patients which limits access to this care. Examining quality outcomes for patients in clinics with and without access to a RD can help define the value of this service. Methods: We used a retrospective cohort design to analyze Total Cost of Care (TCOC), hospital admissions and Length of Stay (LOS), and Emergency Department (ED) and Observation visits for patients with gastric and esophageal cancer who were enrolled in the Oncology Care Model (OCM) during Performance Periods (PP) 1-6 (July 1, 2016 – June 30, 2019). We divided patients from a geographically concentrated metropolitan hub into cohorts based on clinic access to a RD. Each patient’s initial OCM episode of care was used for analysis. Results: We identified 253 OCM patients with gastric or esophageal cancer from PP1-6. Of these, 109 were treated at 9 clinics with an RD and 144 in 16 clinics without a RD. In the RD cohort 42.2% of patients were admitted to the hospital with a LOS of 6.8 days. In the non-RD cohort 45.8% of patients were admitted to the hospital with a LOS of 9.4 days. TCOC for the 6-month episode was lower in the RD cohort at $ 39,033 vs the non-RD cohort at $49,359. There were 0.56 ED and observation visits per patient in the RD cohort and 0.8 ED and observation visits per patient in the cohort without a RD. Conclusions: Amongst OCM patients with gastric and esophageal cancers, treatment at a clinic with a RD was associated with lower TCOC, reduced LOS for patients that were admitted to the hospital and fewer ED and observational visits. This analysis shows the potential benefit of RD services in an outpatient setting and justifies further study. Future prospective studies will need to evaluate which interventions are most impactful.[Table: see text]