PGY-2 Oncology Resident Advocate Aurora Health Milwaukee, Wisconsin, United States
Poster Abstract:
Background: Supportive care remains a substantial driver of oncology-related acute care utilization, with an increasingly burdensome strain on the healthcare system. Recent Medicare spending reports indicate that oncology-related acute utilization constitutes approximately 48% of overall spending, far surpassing the 16% allocated to chemotherapy.1 Moreover, there exists considerable variation in spending across different healthcare institutes, further emphasizing the need to establish standardized spending practices and promote value-based care. To address this challenge, the Centers for Medicare & Medicaid Services (CMS) has introduced OP-35, a chemotherapy measure aimed at enhancing the quality of care for patients undergoing outpatient chemotherapy treatment.2 OP-35 evaluates inpatient admissions or emergency department visits within 30 days of chemotherapy, focusing on ten qualifying admissions. Advocate Aurora Health (AAH) quality tracks OP-35 related metrics on an annual basis.
In response to the need for early detection of supportive care complications, several institutions across the nation have implemented phone triage systems with tailored symptom management algorithms. These interventions have demonstrated remarkable progress in reducing emergency room visits and hospital admissions.
Objective: Introduce algorithm-based triage systems to AAH outpatient cancer clinics, ensuring standardized and timely supportive care to minimize preventable emergency room visits and admissions. By leveraging this approach, we aim to enhance patient outcomes and alleviate the strain on the healthcare system associated with oncology-related acute care utilization.
Methods: System data reports of all AAH Wisconsin care sites were analyzed to evaluate the number and trends of qualifying OP-35 diagnoses post chemotherapy in 2022. The most common diagnoses were selected for developing supportive care algorithms. Through discussions with nursing staff, providers and clinic pharmacists, supportive care algorithms catered to each of the toxicities are currently being developed to guide triaging nurses and streamline the overall process. After approval of the algorithms by the health system governing committees/providers, treatment bundles will be developed to supplement the algorithms, further streamlining the triaging process. Both the algorithms and treatment bundles will serve as the endpoint/product of this project.
Results: 2022 AAH system reports indicated a total of 994 OP-35 qualifying diagnosis admissions occurring within a 30 days period following an outpatient Intravenous chemotherapy treatment. Neuropathic pain, diarrhea, nausea, emesis, and fever were identified as the most common admission diagnosis. Currently the algorithms catered to the previously mentioned most common admission diagnoses are under development therefore results are pending.
Discussion: Pending
Conclusions: Pending
References (must also be included in final poster): 1. Brooks GA, Li L, Uno H, et al: Acute hospital care is the chief driver of regional spending variation in Medicare patients with advanced cancer. Health Aff (Millwood) 33:1793-1800, 2014 2. Chemotherapy Measure (OP-35) Overview. Centers for Medicare & Medicaid Services (CMS).https://qualitynet.cms.gov/outpatient/measures/chemotherapy. Accessed July, 2023. 3. Sprandio JD: Oncology patient-centered medical home and accountable cancer care. Community Oncol 7:565-572, 2010 4. Hoverman JR, Klein I, Harrison DW, et al: Opening the black box: The impact of an oncology management program consisting of level I pathways and an outbound nurse call system. J Oncol Pract 10:63-67, 2014
