|The following article features coverage from the American Society of Clinical Oncology 2019 meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
CHICAGO — Researchers found that screening patients, identifying super-utilizers, and offering enhanced services, such as twice-weekly phone-based evaluations, decreased inpatient admissions and inpatient costs. These findings were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting.
For the study, a nurse practitioner screened patients enrolled in the Oncology Care Model (OCM) during their orientation visit and before they received immunotherapy, cytotoxic drugs, or targeted therapy. “We thought the best time to implement a screening protocol was during the orientation process,” said presenter Manuel C. Perry, MD, of Crystal Run Healthcare in Middletown, New York. In addition to risk stratification, Dr Perry explained, the patient orientation visit between the patient and the nurse practitioner included treatment regimen orientation, explanation of the 13-point National Academy of Medicine (formerly known as the Institute of Medicine) care plan, distress screening, discussion about advanced directives, instructions for care access during and after office hours, and risk stratification.
The risk stratification selection criteria included chronic heart failure, chronic obstructive pulmonary disease, dialysis/renal failure, the presence of a feeding tube, insulin-dependent diabetes, stage IV disease, systemic therapy or oral targeted therapy, stem cell transplantation within the last 3 months, acute leukemia, and prior admission to the hospital within the last 6 months.
Patients who were identified as having one or more of these predisposing factors were offered increased health care services, which included twice-weekly phone calls to discuss the patient’s health status. These calls were made between 8 am and 10 am, a time that nurse practitioners were able to block off on their calendars for making the calls and when patients were likely to be home to receive their call.
In cases where the nurse practitioner learned of a new or worsening condition, a same-day appointment was made for the patient and a relevant member of their oncology care team (ie, nurse practitioner, oncology, primary care physician, or other specialist). All interventions were documented in the patient’s electronic medical record and the oncologist was informed of all changes.
As a result of this intervention, the researchers have found that inpatient admissions have decreased and inpatient costs have decreased, resulting in a savings of nearly $600,000 per year for our OCM cohort of 600 beneficiaries. In addition, patient satisfaction scores increased across multiple categories including access, affective communication, exchanging information, and shared decision making.
“Ongoing addition of high-risk patients and reduced contact with stable patients may improve efficiency,” Dr Perry concluded. “Building relationships, developing trust, and facilitating access are the central components of the program.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Perry M, Rudy-Tomczak K, Lalanne J, et al. A process to reduce hospital admissions in the OCM population through focused intervention of super-utilizers. Oral presentation at: 2019 ASCO Annual Meeting; May 31 to June 4, 2019; Chicago, IL. Abstract 6505.