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Thomas Asfeldt



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    P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.15-21 - Creating an Optimal Care Coordination Model to Improve Multidisciplinary Care for Lung Cancer Patients on Medicaid (ID 12318)

      16:45 - 18:00  |  Author(s): Thomas Asfeldt

      • Abstract
      • Slides

      Background

      The Association of Community Cancer Centers (ACCC) created an Optimal Care Coordination Model (OCCM), which provides a comprehensive self-assessment tool designed to orient cancer programs to achieving patient-centered, multidisciplinary care. The OCCM is designed to help cancer programs, regardless of resources, location, or population, improve care for lung cancer patients, especially those on Medicaid.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using findings from an environmental scan (April 2016) and visits to 5 US cancer programs to explore current care models (July-October 2016), a Technical Expert Panel developed the OCCM, which has 13 defined Assessment Areas and utilizes an evaluation matrix (Table 1).

      To validate the OCCM, a competitive application process among ACCC’s membership used a comprehensive institutional quantitative and qualitative questionnaire. Applicants completed a self-assessment using the OCCM and then developed quality improvement projects designed to move their OCCM-scored care delivery performance from baseline to a higher level over a 12-month implementation period. Seven US community cancer centers were selected as Testing Sites. Quantifiable outcome measures were identified for each site, standardized across sites, and collected by a centralized data coordinating center.

      Table 1

      OCCM Assessment Areas

      1. Patient Access to Care

      8. Survivorship Care

      2. Prospective Multidisciplinary Case Planning

      9. Supportive Care

      3. Financial, Transportation, and Housing

      10. Tobacco Cessation

      4. Management of Comorbid Conditions

      11. Clinical Trials

      5. Care Coordination

      12. Physician Engagement

      6. Treatment Team Integration

      13. Quality Measurement and Improvement

      7. Electronic Health Records and Patient Access to Information

      Level 1:

      Optimal care coordination for lung cancer care has a low priority as evidenced by fragmented care.

      Level 2:

      Early progress in coordinating care is underway.

      Level 3:

      Reflects average or typical care coordination.

      Level 4:

      Exceeds the average and reflects a cancer program’s ongoing commitment to the pursuit of optimal care coordination.

      Level 5:

      Defined by optimal care coordination with a patient-centered focus. Depending on the assessment area, achieving Level 5 performance will require significant time, effort, and resources.

      Patient Focus:

      Optimal care coordination must be patient-centered, which requires understanding of what is important to patients and their caregivers, including their knowledge, goals, needs, desires, social connections, and resources for care. This requires the cancer program to educate and engage patients and caregivers to facilitate shared decision-making and patients’ participation in their care.

      Quality Measures and Metrics:

      Each assessment area requires at least one measurable parameter. Optimal care coordination requires analysis and development of an action plan for continuous improvement. These parameters should include both evidence-based and institution-specific benchmarks that address patient outcomes, patient experience, and cost effectiveness. These measures and metrics should be continuously measured and fed back to key institutional stakeholders for ongoing quality improvement.

      4c3880bb027f159e801041b1021e88e8 Result

      Table 2 shows Assessment Areas being validated and patient demographics.

      Table 2

      Site 1

      Site 2

      Site 3

      Site 4

      Site 5

      Site 6

      Site 7

      TOTAL

      Project # 1 Selected Assessment Area(s)

      #2

      #7

      #10

      #2

      #1

      #5 & #9

      #1

      Project # 2 Selected Assessment Area

      #8

      #11

      n/a

      #10

      n/a

      n/a

      #2

      8 of 13 Assessment Areas being validated

      N=50

      N=29

      N=77

      N=53

      N=76

      N=101

      N=35

      N=421

      Age

      Median

      (IQR)

      70

      (57-76)

      74

      (63-76)

      71

      (57-76)

      65

      (60-71)

      68

      (61-75)

      61

      (55-65)

      66

      (60-73)

      68

      (61-74)

      n (%)

      n (%)

      n (%)

      n (%)

      n (%)

      n (%)

      n (%)

      n (%)

      Sex

      Male

      29 (58)

      14 (48)

      40 (52)

      27 (51)

      49 (64)

      48 (48)

      18 (51)

      225 (53)

      Female

      21 (42)

      15 (52)

      37 (48)

      26 (49)

      27 (36)

      52 (51)

      17 (49)

      195 (46)

      Race

      Caucasian

      46 (92)

      23 (79)

      76 (99)

      51 (96)

      73 (96)

      47 (47)

      27 (77)

      343 (81)

      African American

      4 (8)

      1 (3)

      2 (4)

      5 (5)

      6 (17)

      18 (4)

      Asian

      4 (14)

      8 (8)

      12 (3)

      Other/

      Unknown

      1(1)

      1 (1)

      8(8)

      2 (6)

      12 (3)

      Not reported

      1 (3)

      2 (3)

      29 (29)

      32 (8)

      Insurance

      Commercial

      7 (14)

      7 (24)

      13 (17)

      8 (15)

      29 (38)

      8 (8)

      9 (26)

      81 (19)

      Medicare

      38 (76)

      20 (69)

      55 (71)

      37 (70)

      40 (53)

      28 (28)

      21 (60)

      239 (57)

      Medicaid

      4 (8)

      2 (7)

      6 (8)

      8 (15)

      6 (8)

      63 (62)

      4 (11)

      93 (22)

      None/Self-Pay

      2 (3)

      1 (1)

      3 (1)

      Smoking Status

      Active Smoker

      14 (28)

      10 (34)

      27 (35)

      17 (32)

      38 (50)

      34 (34)

      11 (31)

      151 (36)

      Former Smoker

      20 (40)

      15 (52)

      44 (57)

      34 (64)

      28 (37)

      51 (50)

      23 (66)

      215 (51)

      Never Smoker

      7 (14)

      3 (10)

      2 (3)

      2 (4)

      7 (9)

      9 (9)

      30 (7)

      Not reported

      2 (3)

      1 (1)

      3 (1)

      Stage at Diagnosis

      Stage 0

      2 (3)

      2 (<1)

      Stage I

      9 (18)

      4 (14)

      21 (27)

      1 (2)

      9 (12)

      9 (9)

      2 (6)

      55 (13)

      Stage II

      1 (2)

      2 (7)

      10 (13)

      5 (9)

      3 (4)

      7 (7)

      28 (7)

      Stage III

      6 (12)

      5 (17)

      11 (14)

      3 (6)

      4 (5)

      13 (13)

      2 (6)

      44 (10)

      Stage IV

      6 (12)

      3 (10)

      8 (10)

      14 (26)

      13 (17)

      18 (18)

      4 (11)

      66 (16)

      Not reported/ Missing

      28 (56)

      15 (52)

      25 (32)

      30 (57)

      47 (62)

      54 (53)

      27 (77)

      226 (54)

      *Percentages may not add to 100 due to missing data

      8eea62084ca7e541d918e823422bd82e Conclusion

      Project implementation and patient accrual are ongoing at all Testing Sites through September 2018.

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