Reducing Unwarranted Oncology Care Variation Across a Clinically Integrated Network: A Collaborative Physician Engagement Strategy.

Q1 Nursing

Journal of Oncology Practice Pub Date : 2019-10-01 DOI:10.1200/jop.18.00754

Jon M. Richards, Trever Burgon, D. Tamondong-Lachica, J. Bitran, W. Liangco, David Paculdo, J. Peabody

{"title":"Reducing Unwarranted Oncology Care Variation Across a Clinically Integrated Network: A Collaborative Physician Engagement Strategy.","authors":"Jon M. Richards, Trever Burgon, D. Tamondong-Lachica, J. Bitran, W. Liangco, David Paculdo, J. Peabody","doi":"10.1200/jop.18.00754","DOIUrl":null,"url":null,"abstract":"PURPOSE\nAddressing unwarranted clinical variation in oncology is a high priority for health systems that aspire to ensure consistent levels of high-quality and cost-effective care. Efforts to improve clinical practice and standardize care have proven challenging. Advocate Physician Partners undertook a patient simulation-based practice measurement and feedback project that was focused on breast and lung cancer to engage oncologists in the care standardization process.\n\n\nMETHODS\nOne hundred three medical oncologists cared for online simulated patients using the Clinical Performance and Value platform, receiving feedback on how their care decisions compared with evidence-based guidelines and their peers. We repeated this process every 4 months over six rounds, measuring changes in quality-of-care scores. We then compared simulated patient results with available patient-level claims data.\n\n\nRESULTS\nOver the course of the project, overall quality-of-care scores improved 11.9% (P < .001). Diagnostic accuracy increased 6.7% (P < .001) and correlated with improved treatment scores, including a nearly 10-percentage point increase in evidence-based chemotherapy regimens (P = .009) and a 56% increase in addressing palliative needs for patients with late-stage disease (P < .001). Unnecessary test ordering declined 25% (P < .001). We compared these results with available patient data and observed concordance with the metastatic imaging workup order rate for early-stage breast cancer. As unnecessary workups declined in the simulations and became more closely aligned with evidence-based guidelines, we saw similar rates of decline in the patient-level data.\n\n\nCONCLUSION\nThis study demonstrates that an oncology care standardization system that combines simulated patients with serial feedback increases evidence-based and cost-effective clinical decisions in patient simulations and patient-level data.","PeriodicalId":54273,"journal":{"name":"Journal of Oncology Practice","volume":"1 1","pages":"JOP1800754"},"PeriodicalIF":0.0000,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1200/jop.18.00754","citationCount":"7","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Oncology Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1200/jop.18.00754","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Nursing","Score":null,"Total":0}

引用次数: 7

Abstract

PURPOSE Addressing unwarranted clinical variation in oncology is a high priority for health systems that aspire to ensure consistent levels of high-quality and cost-effective care. Efforts to improve clinical practice and standardize care have proven challenging. Advocate Physician Partners undertook a patient simulation-based practice measurement and feedback project that was focused on breast and lung cancer to engage oncologists in the care standardization process. METHODS One hundred three medical oncologists cared for online simulated patients using the Clinical Performance and Value platform, receiving feedback on how their care decisions compared with evidence-based guidelines and their peers. We repeated this process every 4 months over six rounds, measuring changes in quality-of-care scores. We then compared simulated patient results with available patient-level claims data. RESULTS Over the course of the project, overall quality-of-care scores improved 11.9% (P < .001). Diagnostic accuracy increased 6.7% (P < .001) and correlated with improved treatment scores, including a nearly 10-percentage point increase in evidence-based chemotherapy regimens (P = .009) and a 56% increase in addressing palliative needs for patients with late-stage disease (P < .001). Unnecessary test ordering declined 25% (P < .001). We compared these results with available patient data and observed concordance with the metastatic imaging workup order rate for early-stage breast cancer. As unnecessary workups declined in the simulations and became more closely aligned with evidence-based guidelines, we saw similar rates of decline in the patient-level data. CONCLUSION This study demonstrates that an oncology care standardization system that combines simulated patients with serial feedback increases evidence-based and cost-effective clinical decisions in patient simulations and patient-level data.

查看原文本刊更多论文

减少临床综合网络中未经安排的肿瘤护理变化：一种合作医师参与策略。

目的解决肿瘤学中不必要的临床变异是卫生系统的高度优先事项，这些系统渴望确保高质量和成本效益的护理水平保持一致。事实证明，改进临床实践和规范护理的努力具有挑战性。Advocate Physician Partners开展了一个基于患者模拟的实践测量和反馈项目，重点关注癌症乳腺癌和肺癌，让肿瘤学家参与护理标准化过程。方法103名肿瘤学家使用临床表现和价值平台护理在线模拟患者，接受关于他们的护理决策与循证指南及其同行相比如何的反馈。我们每4个月重复一次这一过程，共六轮，测量护理质量分数的变化。然后，我们将模拟的患者结果与可用的患者级别索赔数据进行了比较。结果在整个项目过程中，整体护理质量评分提高了11.9%（P<.001）。诊断准确率提高了6.7%（P<.001），并与治疗评分的提高相关，包括循证化疗方案增加了近10个百分点（P=.009），晚期疾病患者的姑息治疗需求增加了56%（P<.001）。不必要的检查顺序减少了25%（P<.001）。我们将这些结果与现有的患者数据进行了比较，并观察到与早期乳腺转移成像检查顺序率一致癌症随着不必要的检查在模拟中减少，并与循证指南更加一致，我们在患者水平的数据中看到了类似的下降率。结论本研究表明，将模拟患者与系列反馈相结合的肿瘤学护理标准化系统可以在患者模拟和患者级数据中提高循证和成本效益的临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Oncology Practice Nursing-Oncology (nursing)

CiteScore

4.60

自引率

0.00%

发文量

期刊介绍： Journal of Oncology Practice (JOP) provides necessary information and insights to keep oncology practice current on changes and challenges inherent in delivering quality oncology care. All content dealing with understanding the provision of care—the mechanics of practice—is the purview of JOP. JOP also addresses an expressed need of practicing physicians to have compressed, expert opinion addressing common clinical problems.