TOGETHER Care: PatienT-tailOred GynEcologic Oncology posT discHargE caRe (290)

Abstract

Objectives: Nationwide, gynecologic oncology patients have a 10-15% rate of unplanned re-admissions. With similar rates to national averages, the Division of Gynecologic Oncology at the University of Pennsylvania Health System averages one emergency department visit per day, with nearly 50% of these visits resulting in re-admission. Additionally, high rates of emergency department utilization were noted in patients from underserved communities. Furthermore, it is estimated that 20-30% of re-admissions and emergency department visits by gynecologic oncology patients are preventable, thus indicating the need for optimized outpatient care. Lack of standardized and equitable care negatively affects patient outcomes and satisfaction while also increasing the burden on healthcare providers. To address this, we are implementing a risk-based, standardized patient care program for patients undergoing surgery and/or chemotherapy that incorporates home health services and telehealth. We aimed to determine (1) if it is possible to accurately identify patients as high- or low-risk for emergency department (ED) utilization and readmission and (2) if increased home-based monitoring for high-risk patients allows for early intervention to prevent ED utilization and re-admission, as well as for earlier hospital discharge if admitted. We also believe this program will improve provider workflow, healthcare equity, and patient and provider satisfaction while decreasing healthcare spending. Methods: To address this problem, we are applying a rapid cycle innovation methodology. First, contextual inquiry through chart reviews, patient and provider interviews and surveys, and shadowing of clinical operations are being performed to identify areas for improvement. Next, baseline information is being analyzed to define measurable and modifiable metrics. We will then hypothesize solutions for identified barriers and integrate them into rapid, low-cost, mini pilot programs of <20 patients. Pilots will provide enhanced patient follow-up integrating home health, text messaging, and provider follow-up based on a tiered system. Patient outcomes from pilots will be assessed, and journey mapping of clinical events will be investigated. The format of subsequent pilot programs will be adapted according to these findings, as well as patient and provider feedback. After running 2-5 pilots over six months, we anticipate that we will have a scalable template that can be applied to all patients in our division. This project was undertaken as a Quality Improvement Initiative and, as such, was not formally reviewed by the University of Pennsylvania’s Institutional Review Board. Results: The contextual inquiry began in May 2021, with general themes currently being defined. Our first pilot programs were initiated in August 2021, with results pending. Conclusions: Rapid cycle innovation techniques help adapt and improve care delivery. We look forward to sharing our insights on efficient and risk-based gynecologic oncology care delivery, when available, from our sequential pilot programs. Objectives: Nationwide, gynecologic oncology patients have a 10-15% rate of unplanned re-admissions. With similar rates to national averages, the Division of Gynecologic Oncology at the University of Pennsylvania Health System averages one emergency department visit per day, with nearly 50% of these visits resulting in re-admission. Additionally, high rates of emergency department utilization were noted in patients from underserved communities. Furthermore, it is estimated that 20-30% of re-admissions and emergency department visits by gynecologic oncology patients are preventable, thus indicating the need for optimized outpatient care. Lack of standardized and equitable care negatively affects patient outcomes and satisfaction while also increasing the burden on healthcare providers. To address this, we are implementing a risk-based, standardized patient care program for patients undergoing surgery and/or chemotherapy that incorporates home health services and telehealth. We aimed to determine (1) if it is possible to accurately identify patients as high- or low-risk for emergency department (ED) utilization and readmission and (2) if increased home-based monitoring for high-risk patients allows for early intervention to prevent ED utilization and re-admission, as well as for earlier hospital discharge if admitted. We also believe this program will improve provider workflow, healthcare equity, and patient and provider satisfaction while decreasing healthcare spending. Methods: To address this problem, we are applying a rapid cycle innovation methodology. First, contextual inquiry through chart reviews, patient and provider interviews and surveys, and shadowing of clinical operations are being performed to identify areas for improvement. Next, baseline information is being analyzed to define measurable and modifiable metrics. We will then hypothesize solutions for identified barriers and integrate them into rapid, low-cost, mini pilot programs of <20 patients. Pilots will provide enhanced patient follow-up integrating home health, text messaging, and provider follow-up based on a tiered system. Patient outcomes from pilots will be assessed, and journey mapping of clinical events will be investigated. The format of subsequent pilot programs will be adapted according to these findings, as well as patient and provider feedback. After running 2-5 pilots over six months, we anticipate that we will have a scalable template that can be applied to all patients in our division. This project was undertaken as a Quality Improvement Initiative and, as such, was not formally reviewed by the University of Pennsylvania’s Institutional Review Board. Results: The contextual inquiry began in May 2021, with general themes currently being defined. Our first pilot programs were initiated in August 2021, with results pending. Conclusions: Rapid cycle innovation techniques help adapt and improve care delivery. We look forward to sharing our insights on efficient and risk-based gynecologic oncology care delivery, when available, from our sequential pilot programs.