|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.
Inpatient (IP) and emergency department (ED) admissions and their associated costs are meaningfully reduced when telephonic nurse care management is used to manage patients receiving chemotherapy, according to research presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago.
The goal of care management is to improve the quality of cancer care and reduce its cost. Craig A. Hunter, of CVS Health, and colleagues sought to evaluate IP and ED admissions and costs for patients who received telephonic nurse care management while undergoing and immediately after chemotherapy treatment compared with those who did not receive telephonic nurse care management.
An oncology pathways intermediary reached out to patients who were prescribed or initiating treatment with a high-toxicity chemotherapy agent within the previous 60 days. The investigators followed 1609 patients over a 35-month period, 802 of whom enrolled in a voluntary holistic telephonic nurse care management program. The remaining 807 patients in the study did not receive telephonic nurse care management.
Nurse care managers engaged patients one or more times per month based on patient need. They provided education on side effects, pain management, where to seek care, and general well-being. IP and ED admissions during a 14-day risk period following chemotherapy administration were compared with a baseline of all remaining patient claims history, excluding 14-day risk periods and 14-day washout periods (total of 28 days) following chemotherapy administration.
The investigators reported IP admissions per 1000 risk-period days decreased by 44% from baseline (3.02 vs 5.39; P ≤.001) in the managed group, whereas admissions increased by 29% from baseline in the nonmanaged group (2.33 vs 1.81; P =.003). No significant difference was observed in ED admissions per 1000 risk-period days compared with baseline in the managed group (2.72 vs 2.35; P =.188); however, ED admissions were significantly higher — an increase of 117% from baseline — in the nonmanaged group (2.34 vs 1.08; P ≤.001).
In addition, cost per admission in the managed group decreased in the risk-period compared with baseline: $38,606 vs $44,006 for IP admissions and $1173 vs $1292 for ED admissions. In the nonmanaged group, costs per IP admission decreased in the risk period compared with baseline ($49,557 vs $52,863), but increased for ED admissions ($1211 vs $1146).
The investigators found that baseline utilization in the managed group was more than twice that in the nonmanaged group; therefore, the results suggest a greater need for support may influence patients’ decision to participate in care management.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Hunter CA, Krueger AC, Soliman OA, Inman AS, Glenn ER, Johnson KA. Evaluating the impact of telephonic nurse care management during high toxicity chemotherapy treatment. Poster presented at: 2019 ASCO Annual Meeting; May 31 to June 4, 2019; Chicago, IL. Abstract 6623.