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For Immediate Release: November 30, 2010
Association of Community Cancer Centers Releases Study on Care Transition Between Hospitals and Outpatient Oncology Groups
Considerable Challenges, Innovative Solutions, and Substantial Progress Are Noted
ROCKVILLE, Md.—The Association of Community Cancer Centers (ACCC) has released a study of how—and how well—the cancer patient’s transition from the hospital inpatient setting to outpatient oncology group is managed. Findings suggest that some community cancer programs have developed innovative solutions to manage various aspects of the transition process. Still, there is room for further improvement in developing specific processes and policies designed to manage the cancer patient’s transition between care settings.
"ACCC examined components of the care transition, including the adequacy and completeness of the medical record, medication reconciliation, and communication among providers—both within their own programs and between the two care settings," said ACCC President Al B. Benson III, MD, FACP. "Our goal was to understand the challenges involved in transitioning patients between settings and to identify best practices for ensuring a smooth transition."
The summary of findings and final report are available on ACCC's website at www.accc-cancer.org.
Among the findings:
- Few hospitals in the study monitor readmissions or follow up with their discharged patients.
- Oncology-specific transition policies are largely non-existent (3 percent of surveyed hospitals have one).
- Transition checklists are rare (15 percent of surveyed hospitals manage the transition with a checklist).
- While some organizations had transition programs in place, few of them are using survey and measurement tools to analyze those processes for quality improvement.
- The transition challenge is to identify and manage the patient and family needs at a time and in a location in which neither system (hospital nor oncology group) has control, accountability, or responsibility.
Generally, there has been substantial progress in recent years in introducing electronic health records (EHR) and computerized physician order entry (CPOE) systems into hospitals and oncology practices. Those systems have greatly improved medication reconciliation and the ability of community oncologists to access appropriate medical records pertaining to their recently hospitalized patients.
Overall, a number of challenges remain: Patients move between two modes of care that are generally operated by two separate organizations, often without common information systems and sometimes with only limited shared information. Hospitals compete with each other for patients, as do physicians, and sometimes the competition can get in the way of good communication during the patient transition. The cost of managing the transition is not built into the reimbursement structure. And multiple challenges can occur in the electronic transfer of usable data between the hospital and the oncology group EHR systems, especially for medical groups admitting patients to several hospitals.
Nine community cancer programs were identified from among survey respondents as providing exemplary activities related to transitioning cancer patients between care settings.
This education program was made possible through an educational grant from Eisai Inc. Health2 Resources provided strategic advisory services and analysis for this program.
Project Methodology. Two online surveys were developed: one for oncology physician practices and the other for hospital-based oncology programs. The surveys focused on issues in the cancer patient's transition from inpatient hospital care to oncologist-provided care in an outpatient or office practice setting. Nearly 100 participants completed the surveys.
Metrics for evaluating the quality of transition activities were developed by reviewing frequency distributions for key transition variables, and then developing a metric that summarizes the individual transition activities of hospitals into a composite measure of transition activities, medication reconciliation activities and technologies, and medical record/discharge summary compilation and transmission activities and technologies. These metrics were used to select nine appropriate sites (five hospital programs and four oncology practices) for in-depth interviews, which were translated into case examples.
The final report includes descriptions of the transition challenges, a review of care transition literature, survey results and key findings, and case examples, and is designed to fulfill ACCC’s learning objectives for the project to raise participants’ awareness about potential problems in patient transition between hospital and physician practice settings. ACCC will further examine transition challenges within a special issue of Oncology Issues, March/April 2011. ACCC will profile the nine “exemplary” programs as well as offer descriptions of processes that these programs use in patient transition and include practical tools, such as discharge instructions, patient hand-off sheet, and patient navigator checklist, among others.