Abstract
e18720 Background: Virginia Cancer Institute (VCI) participated in the Oncology Care Model (OCM) with an aim to improve cancer care quality. As part of OCM, VCI started a palliative care program (PC) in 2016 by partnering with a local palliative care provider. In September 2020, VCI overhauled PC moving away from outside provider (OPC) and created an internal program (IPC). Both programs managed care from VCI oncologist referrals to PC until patient’s hospice start or practice discharge. This study describes the methods or changes from OPC to IPC and the resulting difference in hospice quality measure performance. Methods: Under OPC, services were provided half-day per week in office from a PC nurse practitioner (NP). IPC changed to a PC NP employed by VCI who provided services 5 days per week with office, hospital and telemedicine options. IPC added multiple PC education, communication touchpoints with oncologists and practice staff. IPC provided reminders to VCI physician teams about the availability of in-house PC services and the benefits of early engagement. Along with the oncologists, IPC continued goals of care discussions with patients and family to ensure patients’ desires and needs were met. OPC hospice referrals from PC went to a single hospice group. IPC added a network of multiple hospice groups. Retrospective claims review of OCM performance periods (PP) 1-8 (Jul 2016 – Dec 2020) for OPC and OCM PP 9-10 (Jul 2020 – Dec 2021) for IPC was performed and excluded patients with incomplete hospice claims. Primary endpoint was difference between OPC and IPC in OCM-3 quality: proportion of OCM patients who died during their episode with 3 or more days hospice immediately prior to death. Secondary endpoint was the difference in proportions of OPC and IPC with any hospice length of stay. Z-test between 2 proportions was used to calculate significance. Results: There were 871 and 197 OCM-3 eligible patients reviewed from OPC and IPC respectively. OCM-3 quality performance was 48.1% OPC and 62.4% IPC, p < 0.01. Any hospice performance was 65.8% OPC and 78.7% IPC, p < 0.01. The OCM-3 goal throughout for maximum quality score was 60%. Performance improvement started in the first IPC period (PP9) and was greater in the second IPC period (PP10). Conclusions: Results showed a significant improvement in OCM performance measures between OPC and IPC over a short period of 10 months. After IPC, practice met the OCM-3 goal. The data is limited to latest available OCM reconciliation claims and may be refreshed when additional OCM data is released. Although specific cause and effect was not assessed, the authors attribute quality improvement to the implementation of an internal, full-time PC NP. This expanded PC access for patients and increased communication between patients and providers. We believe that, as a result, the quality of care delivery improved.
Published Version
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