Providers' concordance with survivorship clinical algorithms.

Abstract

243 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in the survivorship lymphoma algorithm. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in the lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: 63 survivors were seen in the Lymphoma Survivorship Clinic from 05/01 to 09/30/2012 and all received Passports. A provider tailored the plan to each survivor’s needs and counseled the individual on disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for recurrence/late treatment effects. Results indicated 100% of survivors received a physical exam, including cardiovascular screening. Similar rates were also achieved for CBC testing, chest X-rays, and counseling survivors on screening recommendations relevant to: breast, cervical, colorectal and prostate cancers. Other counseling rates included 97% for skin exam recommendations and 100% for maintaining adult vaccinations. Finally, providers’ concordance with assessment of survivors’ psychosocial distress was 100%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.