OCM community oncology palliative care program: Sites of patient care in last 180 days before hospice or death by cancer types.

Abstract

69 Background: Michigan Health Professionals (MHP) participates in Oncology Care Model (OCM). A community oncology program for early and timely involvement of palliative care (PC) was launched in 2017 to achieve OCM goals of high quality, cost-effective, coordinated care. Previously, we showed that early enrollment in PC increased hospice utilization, decreased hospitalization and outpatient facility cost in last 30-days of death or end of OCM episode. PC improved quality of care in OCM patients. This study aims to see the effect of PC by patient care setting in the last 180-days before hospice or death. Methods: Retrospective claims review was performed with PC patients referred from September 2017 – December 2018. Last 180-days was defined by the entry into hospice, patient death, or OCM claim limit (12/31/2018), whichever was first to occur. OCM claims were analyzed by Integra Connect. Patient care setting utilization, in days (LOS), was identified for FACILITY: inpatient, skilled nursing, outpatient facility (ER, observation, etc.), physician office, and HOME HEALTH: home health agency visits. When no claim was found within the last 180-days, the patient was assumed to be at home or with no-care (HOME). Results: PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH care settings and more days at HOME vs PC declined or unable to reach (average difference of 14 days). PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. matched PC-not referred patients who died or entered hospice (average difference of 26 days). In lung cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 27 days). In pancreatic cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 17 days). Conclusions: Patients who are PC-Engaged spent more time at home and less time in facilities over the last 6 months before end-of-life. Patients who were referred to PC with advanced lung and pancreatic cancer showed the most opportunity for impact with PC engagement. Study was limited by OCM claims available as of June 2019. Results may be refreshed as more data becomes available.