Brandon Anderson, Liisa Lyon, Michael Lee, Deepika Kumar, Elad Neeman, Ali Duffens, Dinesh Kotak, Hongxin Sun, Mary Reed, Raymond Liu
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引用次数: 0
摘要
背景:安全信息(Secure Messaging,SM)的广泛应用为癌症患者提供了前所未有的接触医疗服务提供者的机会,但却增加了肿瘤专家的工作量。在此,我们分析了肿瘤安全信息服务的临床内容和敏锐度,并将其转化为因减少预约而节省的估计成本:这项以人群为基础的回顾性队列研究检查了患者在一年内(2021 年 6 月 1 日至 2022 年 5 月 31 日)通过患者门户网站或应用程序交换的由患者发起的 SM 线程的内容,这些线程在 21 个凯泽医疗集团北加州肿瘤诊所中交换,这些诊所通常没有与 SM 相关的患者共付额。随机抽样审查了 500 条 SM 线程,并按照信息内容、严重程度和适当的服务级别进行了分类。通过成本和时间估算,比较了肿瘤专家单独管理 SM 与医疗助理和护士协助管理 SM 的成本:研究期间,41272 名患者向 132 名肿瘤专家发送了 334053 条独特的 SM 信息。在审查过的 SM 线程中,只有 26.8% 需要肿瘤学家的专业知识。根据线程内容,其余 73.2%的线程可能由护士(38.2%)、医疗助理(28.4%)、初级保健医生(5.4%)或其他亚专科医疗服务提供者(1.2%)进行更好的管理。在 2.4% 的病例中,建议进行急诊治疗。在所查看的主题中,有 24.4% 的患者获得了通常需要预约的重要医疗服务。我们估计 SM 交流提供了 1120 万美元的医疗服务,其中包括避免了 360 万美元的患者自付费用和 760 万美元的漏记账单代码:大量使用 SM 为肿瘤学家带来了额外的工作量,而这些工作量大多可由其他医疗服务提供者适当管理。通过 SM 提供的无偿医疗服务的规模以及在紧急医疗情况下使用 SM,迫切需要新的实践模式。分流、管理和结算 SM 的替代架构可以降低成本,减轻肿瘤学家的倦怠感。
Empowering Care Teams: Redefining Message Management to Enhance Care Delivery and Alleviate Oncologist Burnout.
Background: Widespread adoption of secure messaging (SM) provides patients with cancer with unprecedented access to medical providers at the expense of increased workload for oncologists. Herein, we analyze oncology SM clinical content and acuity and translate these to estimated cost savings from reduced appointments.
Methods: This population-based retrospective cohort study examined the content of patient-initiated SM threads exchanged through the patient portal website or app over 1 year (June 1, 2021-May 31, 2022) at 21 Kaiser Permanente Northern California oncology practices, which typically do not have patient copayments associated with SM. A random sample of 500 SM threads were reviewed and categorized by message content, acuity, and appropriate level of service. Cost and time estimates were used to compare the cost of SM management by oncologists alone versus assisted by medical assistants and nurses.
Results: During the study, 41,272 patients initiated 334,053 unique SM threads to 132 oncologists. Of the SM threads reviewed, only 26.8% required oncologist expertise. Based on thread content, the remaining 73.2% may have been better managed by a nurse (38.2%), medical assistant (28.4%), primary care physician (5.4%), or another subspecialty provider (1.2%). Emergency care was recommended in 2.4% of the threads reviewed. Significant medical care was provided to patients in 24.4% of the reviewed threads that would typically require an appointment. We estimate that the SM exchanges provided $11.2 million in care, including $3.6 million in avoided out-of-pocket copayment costs to patients and $7.6 million in missed billing codes.
Conclusions: High utilization of SM generates additional workload for oncologists that could mostly be appropriately managed by alternate providers. The magnitude of unreimbursed medical care provided via SM and the use of SM for emergent medical situations creates an urgent need for new practice models. An alternative architecture for triaging, managing, and billing SM could reduce costs and oncologist burnout.
期刊介绍:
JNCCN—Journal of the National Comprehensive Cancer Network is a peer-reviewed medical journal read by over 25,000 oncologists and cancer care professionals nationwide. This indexed publication delivers the latest insights into best clinical practices, oncology health services research, and translational medicine. Notably, JNCCN provides updates on the NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®), review articles elaborating on guideline recommendations, health services research, and case reports that spotlight molecular insights in patient care.
Guided by its vision, JNCCN seeks to advance the mission of NCCN by serving as the primary resource for information on NCCN Guidelines®, innovation in translational medicine, and scientific studies related to oncology health services research. This encompasses quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship.
JNCCN boasts indexing by prominent databases such as MEDLINE/PubMed, Chemical Abstracts, Embase, EmCare, and Scopus, reinforcing its standing as a reputable source for comprehensive information in the field of oncology.