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Lorna Lucas
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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): Lorna Lucas
- Abstract
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.
4c3880bb027f159e801041b1021e88e8 ResultTable 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.
Table 2 shows Assessment Areas being validated and patient demographics.
8eea62084ca7e541d918e823422bd82e ConclusionTable 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
Project implementation and patient accrual are ongoing at all Testing Sites through September 2018.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.15-20 - Educating The Multispecialty Team on Molecular Testing Related to Immunotherapy (ID 12785)
16:45 - 18:00 | Author(s): Lorna Lucas
- Abstract
Background
Clinical guidelines for metastatic non-small cell lung cancer (NSCLC) increasingly include molecular testing for actionable biomarkers related to immuno-oncology (IO) use in lung cancer patients. While precision therapies targeting the PD-1/PD-L1 pathway have the potential to improve patient response rates, there is ambiguity regarding optimal biomarker testing and care coordination for NSCLC patients. To address this disparity in health care delivery, an online education program on molecular testing related to immunotherapies was developed for multispecialty providers. Learner responses were evaluated to determine the educational impact.
a9ded1e5ce5d75814730bb4caaf49419 Method
A thoracic surgeon, medical oncologist and pathologist developed a curriculum to address the current diagnostic landscape in IO, the value of testing and patient response rates, and how to optimize care coordination and communication among multispecialty team members. In February 2018, a live-online 1-hour video panel discussion with slides, participant polling, and live questions was produced and made available on-demand. Survey responses (pre-test, post-test, 4 weeks post-activity), polling responses, and live questions were tracked to measure knowledge gaps, lessons learned, and educational needs. Demographic information was collected for generalizability.
4c3880bb027f159e801041b1021e88e8 Result
Seventy-one learners participated in the live webinar; 64 learners on-demand (n=135). Learners were actively engaged for an average of 35.19 minutes (out of 52 minutes). Learners represented 11 unique disciplines and specialties. Most learners indicated specializing in oncology (55%), were practicing physicians (31%), and saw 1-10 new patients on an IO therapy each week (72%) in a hospital-based setting (35%). Seven audience questions were asked prior to, and during the live session. Thirty of 135 learners completed all pre/post/follow-up surveys, 96% of which reported they will actively utilize the knowledge gained into their clinical practice. Because of the education provided, learners reported improvements in their ability to: identify patients to test and treat with IO (75%), comprehend the current diagnostic landscape in IO (100%), and optimize communication and coordination of IO testing (100%). Learners also demonstrated improved comprehension via case study by identifying the optimal next step for a NSCLC clinical stage I patient referred by an oncologist for surgical resection who was found to have pleural disease intraoperatively.
8eea62084ca7e541d918e823422bd82e Conclusion
The rapid expansion of cancer immunotherapy-based options for patients with lung cancer requires providers to stay abreast on guidelines related to molecular testing. Continued refinement of care coordination practices between multispecialty team members and education on the value of molecular testing is recommended to improve the diagnosis and appropriate treatment decisions for patients with lung cancer.
6f8b794f3246b0c1e1780bb4d4d5dc53
