April 2016, Vol. 5, No. 3
Data Drive Quality Improvement in an Oncology Patient-Centered Medical Home
Aggregated real-time data provide the tools to rapidly identify opportunities for improvement of delivered services and initiation of quality improvement projects. Enhanced IT capabilities like the iRiS software app are foundational for practice transformation to future value-based cancer care models, according to John Sprandio, MD, Medical Oncologist and Chief Physician at Consultants in Medical Oncology and Hematology (CMOH) in Newtown Square, PA. CMOH, a practice with 3 locations serving 2 health systems and 5 hospitals in the suburbs of Philadelphia, demonstrated that standardized processes and enhanced IT capabilities like iRiS provided a rapid learning system for the practice. Data aggregated by iRiS became the basis for quality improvement projects (QIPs), allowing CMOH to continue to improve in quality and cost measures, Sprandio explained at the 2016 ASCO Quality Care Symposium in Phoenix, AZ.
In 2010, CMOH became the first oncology practice recognized by the National Committee for Quality Assurance as a level III Patient-Centered Medical Home.
“The model that we’ve been working on for a number of years is an Oncology Patient-Centered Medical Home model of care, where there is a great deal of standardization of process roles and responsibilities,” he said. “We’ve developed a software overlay which collects data directly from patients, organizes it in a standardized way, and presents it in a format that is essentially a template for documentation.”
Initiating a Quality Improvement Project
A review of 2012 data at CMOH identified an increase in their rate of hospitalizations, initiating a QIP. Data, processes, and staff were observed at all 3 practice sites, and inconsistent processes in telephone triage symptom management were identified at 1 of the 3 practice locations. “It was determined that symptom calls in the early to mid-afternoon were being directed to the ER, and a higher percentage of these evaluations resulted in admissions,” said Sprandio.
After analysis of site-specific performance, steps were taken to restructure roles and internal processes. Staff was adjusted (a nurse practitioner was added at the site), telephone triage services were adjusted from 3 sites to 1 site to reduce variability in execution, algorithms were reviewed and revised, education materials were improved to enhance patient engagement, and nursing and physician actions were streamlined around triage-related processes.
“This resulted in resetting our trend in ER utilization and admissions, increasing the number of calls into the telephone triage service, increasing the percentage of symptoms managed at home, and decreasing the number of office visits within 24 hours,” Sprandio reported.
“This is just an example of having tools and systems in place so that data are collected and reported, and data collection processes and reporting processes continue to be refined,” he added. “Quality is the degree to which the services in a center can increase the likelihood for desired outcomes.”
“This System Works”
“Dr Sprandio is a pioneer in his space,” said Deborah Schrag, MD, MPH, Health Services Researcher and Medical Oncologist at Dana-Farber Cancer Institute. “He has identified opportunities to build value in oncology care by integrating across traditional boundaries, building a team culture of responsibility by anticipating patient needs and problems, and building a bedrock solid data platform, and he has really tried to move up the ladder from descriptive to predictive analytics.”
“This system works, as they were able to decrease their hospitalizations and adverse events,” she added. “Dr Sprandio’s model is a prototype to try to help us understand and adapt as we’re required to switch away from fee-for-service systems.”
The number of genes associated with breast cancer risk continues to increase. Recently, through whole exome sequencing, 2 groups of researchers have demonstrated that mutations in RECQL increase the risk of breast cancer.1 The first paper, by Cybulski and colleagues, was published online in Nature Genetics in April 2015, and [ Read More ]
Interest in high-throughput (HT) ex vivo cell screening of an individual’s cells for personalized cancer treatment is on the upswing, largely due to improvements in technology and assay development. Attempts decades ago to implement the strategy, which assesses the sensitivity and resistance of tumor cells to a panel of drugs [ Read More ]