[Abstract] Establishing a Multi-Location Quality Improvement Initiative

Presenters:

Amanda Kramar¹, Lorna Lucas, MSM¹, Amy Marbaugh¹, Monique Dawkins, MPA^1
1Association of Community Cancer Centers, Rockville, MD, US

Background 

The Association of Community Cancer Centers (ACCC) has created and is currently validating an Optimal Care Coordination Model (OCCM) that addresses access to high quality cancer care for patients with lung cancer on Medicaid. The overarching goal of this study is to provide patients, healthcare providers, and payers a scalable plan for outreach and treatment to serve as a pilot for cancer programs nationwide.

The purpose of the OCCM is to provide practical guidance to cancer programs in their efforts to achieve patient-centered, multidisciplinary, coordinated care for patients with lung cancer on Medicaid across the care continuum. The OCCM is a comprehensive self-assessment tool designed to orient cancer programs to the range of activities and tasks available to improve care for this target population.

The OCCM is beneficial to all cancer programs, whether rural, urban or suburban; hospital- or non-hospital-based; academic or non-academic; and at all resource levels, to improve lung cancer care for patients with Medicaid. OCCM was tailored to specifically evaluate 13 areas of high impact, optimal care for lung cancer patients.  The OCCM assesses care coordination from the time of initial patient referral to the cancer program throughout survivorship and end of life.

Methods 

To validate the OCCM, ACCC conducted a competitive application process among the association’s cancer program membership. The application process included a comprehensive questionnaire distributed electronically to assess the cancer program’s patient population, including: total number of analytic cancer patients in 2015 and the number of analytic lung cancer patients, both then stratified by Medicaid-only and Medicare/Medicaid insurance; geographic location of the cancer program; cancer program electronic health record utilization; and quality measurements (individual data collection processes, patient-reported outcomes, and previous involvement in quality improvement initiatives). Applicants were also instructed to complete a program self-assessment using the 13 OCCM assessment areas to determine where improvement was evident. Upon completion of the self-assessment, applicants drafted at least 1 quality improvement (QI) project with identified outcomes measures that their cancer program could implement over a 12-month implementation period.

Twenty-five cancer programs expressed interest in participation; 11 complete applications were submitted; and 7 applications were accepted for participation in validating the model.

To aid the project, a variety of consultants were utilized, including: a lead clinical researcher, biostatisticians, epidemiologists, data managers, quality improvement specialists, and clinical operations specialists. Over a four-month period (June-September 2017), these consultants and ACCC staff provided 100+ hours support via phone, email, and in-person visits to help the7 Testing Sites enhance their QI projects and prepare their cancer programs for implementation of the 12-month validation period. One-hundred percent of selected Testing Sites successfully launched QI projects in October 2017.

Results

All Testing Sites utilized REDCap for data collection and reporting. Each QI project utilized specific quality measures, dependent on: data points collected, the intent of the project, and the needs of the cancer program. Some Testing Sites were validating the same assessment area but approaching the validation differently with respect to implementing the QI project. Whenever possible, the same measures were being captured across projects. All sites collected patient demographic information.

Patient-level measures being evaluated include: number of patients who were screened for tobacco use; number of patients who reported engaging in shared-decision making; number of patients willing to participate in clinical trials after education was provided; and number of patients per month who received a survivorship care plan and treatment summary.

Other measures being evaluated are institution-level focused, including: number of patient cases presented at multidisciplinary conferences; number of patients whose treatment was pathway-compliant based on recommended to actual care delivered); and usage documentation of qualified EMR for patient referrals.

Final results from the data collection will be available for dissemination in 2019.