Clinical Review Abstract
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Potential cost savings of a continuous quality improvement (CQI) program as part of an oncology medical home.
Health Services Research
2013 ASCO Annual Meeting
J Clin Oncol 31, 2013 (suppl; abstr e17579)
Author(s): Daniel Winn, Winston Wong, Joseph Cooper, Tim Olson, Ram Swarup Trehan, Jeffrey A. Scott, Bruce A. Feinberg; CareFirst BlueCross Blue Shield, Baltimore, MD; CareFirst BlueCross BlueShield, Baltimore, MD; Cardinal Health Specialty Solutions, Dublin, OH; Greater Washington Oncology Associates, Rockville, MD
Background: CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions (CHSS) to launch the first cancer care clinical pathway in the United States in August 2008. Due to the early success of the program with regard to savings and physician participation and compliance, CFBCBS and CHSS piloted an oncology medical home program in January 2011 as an attempt to further decrease cancer care costs. The medical home program encouraged physician commitment to an intensive CQI program. We analyzed the potential savings of this program over 1 year. Methods: Data were collected from April 2011 to May 2012. The CQI measurements were obtained from a monthly online survey, completed by medical home participating practices, regarding patient (pt) accrual, clinical profiles, treatment regimens, adverse events, clinical outcomes, and end-of-life care. Two components of the CQI program were analyzed: (1) a 24-48 hour post-treatment follow-up contact by nurses triggered by the initial visit for chemotherapy, and (2) an end-of-life initiative comprised of queries to identify patterns of care in the final days of pts with terminal cancer. Results: Fourteen practices (31 physicians, 478 pts) joined the medical home program. Of the 51 pts who received cycle 1 day 1 of chemotherapy, 38 (75%) were contacted by a nurse within 24-48 hours. Clinical interventions were made for 15 of 38 pts (39%); 5 (13%) involved a return to the clinic. Fifteen pt deaths occurred in year 1. Five (42%) of these pts were in hospice for 0-7 days prior to death, 2 (17%) for 8-14 days, and 4 (33%) for 15+ days. Twelve (80%) of these pts received hospice referral. One pt (6.5%) received chemotherapy within 14 days of death. Seven pts were hospitalized within 14 days of death, and 3 (20%) pts died in the hospital. Conclusions: The nurse follow-up program resulted in prevention of no less than 5 and as many as 15 emergency room visits, and 3-10 related hospitalizations were likely prevented by this intervention. A CQI program can positively impact savings through presumed reductions in emergency room and hospital admissions. Combining these reductions with an end-of-life care initiative represents a great opportunity for cost savings.
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