Implementation of the Institute of Medicine treatment plan in oncology practice.

Abstract

e19233 Background: Participation in the Center for Medicare and Medicaid Services (CMS) value-based payment reform, The Oncology Care Model, requires that every beneficiary has a documented 13-point Institute of Medicine (IOM) treatment plan (TP) when commencing antineoplastic therapy. The intent of this document is to enhance shared decision making between the patient and care team by providing transparent treatment recommendations and engaging patients and caregivers in meaningful discussion. There is limited discussion in the literature on how to adapt the CMS recommendations to diverse practice settings while maintaining fidelity to the intent of the TP. Methods: We compare how three clinically and geographically unique OCM participating institutions implemented the TP in their respective institutions within the domains of the Consolidated Framework for Implementation Research (CFIR). Settings include a community cancer institute in the northeast, an academic hospital setting in the southeast, and a large community cancer network in the southern United States. Results: We identified similar themes in implementation including engaging stakeholders, leveraging information technology, structuring the TP, development of clinic processes and considering scalability. We also describe adaptations unique to the culture and setting of each site. Conclusions: Although studies have shown patients do not feel informed of their diagnosis, there are currently many approaches to improving shared decision making including utilizing the 13 points of the IOM TP as mandated by the OCM. We provide practical strategies for incorporation of the TP into clinical care with lessons from diverse settings. As shown by the wide variability in implementing shared decision making, further research is needed to optimize illness understanding. Additionally, optimal implementation of CMS’s IOM TP would ideally include concrete metrics measuring impact on shared decision making, illness understanding, or patient satisfaction.