scholarly journals Commentary: Quality nutrition care is integral to the Oncology Care Model

2021 ◽  
Author(s):  
Mary Beth Arensberg ◽  
Beth Besecker ◽  
Laura Weldishofer ◽  
Susan Drawert
Keyword(s):  
Best Practice ◽  
Treatment Guidelines ◽  
Nutrition Therapy ◽  
Care Model ◽  
Nutrition Care ◽  
Ambulatory Oncology ◽  
Oncology Care ◽  
Improvement Programs ◽  
And Performance ◽  
Registered Dietitian Nutritionists

AbstractThe Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services (CMS) specialty model implemented in 2016, to provide higher quality, more highly coordinated oncology care at the same or lower costs. Under the OCM, oncology clinics enter into payment arrangements that include financial and performance accountability for patients receiving chemotherapy treatment. In addition, OCM clinics commit to providing enhanced services to Medicare beneficiaries, including care coordination, navigation, and following national treatment guidelines. Nutrition is a component of best-practice cancer care, yet it may not be addressed by OCM providers even though up to 80% of patients with cancer develop malnutrition and poor nutrition has a profound impact on cancer treatment and survivorship. Only about half of US ambulatory oncology settings screen for malnutrition, registered dietitian nutritionists (RDNs) are not routinely employed by oncology clinics, and the medical nutrition therapy they provide is often not reimbursed. Thus, adequate nutrition care in US oncology clinics remains a gap area. Some oncology clinics are addressing this gap through implementation of nutrition-focused quality improvement programs (QIPs) but many are not. What is needed is a change of perspective. This paper outlines how and why quality nutrition care is integral to the OCM and can benefit patient health and provider outcomes.

The patient experience: Patient characteristic differences in response.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 144-144
Author(s):  
Stephen Flaherty ◽  
Constance Barysauskas ◽  
Paul J. Catalano
Keyword(s):  
Patient Experience ◽  
Representative Sample ◽  
Sampling Strategy ◽  
Patient Characteristics ◽  
Population Based ◽  
Ambulatory Oncology ◽  
The Press ◽  
Oncology Care ◽  
And Performance ◽  
Oncology Center

144 Background: Understanding and addressing patient experience (PX) is an integral part of oncology care. The Press Ganey Outpatient Oncology instrument is used to better understand PX and performance differences at a large ambulatory oncology center. We investigated select patient characteristics of response among all eligible patients, the surveyed sample, and survey respondents. Methods: Over a six month period at a large ambulatory oncology center, 26,660 patients were eligible to report their PX. 11% of patients were identified following the center’s sampling criteria, of which Press Ganey applied their sampling strategy. Thus, 2,857 patients were randomly selected and sent the survey instrument, of which 828 patients responded. Patient characteristics of the three cohorts were compared across the center and by disease center. Results: Surveyed patients were a representative sample of eligible patients, as surveyed patients were of similar age (NS), gender (NS), education level (NS), and primary insurer (NS). In some dimensions, responders were not a representative sample of eligible/surveyed patients. Respondents were slightly older (p < 0.001), more often male (NS), more college educated (NS), and more frequently had a primary insurance of Medicare (p < 0.001). Similar population differences continued among eligible, surveyed and responders, in further comparisons by disease center. Conclusions: Population based sampling allowed the opportunity to investigate accuracy of the sampling strategy and the ability to identify a representative sample of patients across the oncology center. A comparison across the oncology center and disease centers revealed we cannot assume respondents are similar to the eligible and surveyed populations, thus we caution all assumptions made with unadjusted PX comparisons. Further research allows the opportunity to continuously update/improve the sampling strategy and administer electronic surveys to identify a more representative sample better positioned for future quality improvement opportunities. [Table: see text]

Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Renee M Sednew ◽  
Kathleen O’Neill
Keyword(s):  
Best Practices ◽  
Performance Improvement ◽  
Best Practice ◽  
Learning Collaborative ◽  
Collaborative Model ◽  
Stroke Registry ◽  
Chicago Area ◽  
Regional Collaboration ◽  
Content Expert ◽  
And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

Impact of cancer- and patient-level factors on provider risk in the Oncology Care Model.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18852-e18852
Author(s):  
Basit Iqbal Chaudhry ◽  
Andrew Yue ◽  
Shuchita Kaila ◽  
Kay Sadik ◽  
Lisa Tran ◽  
...  
Keyword(s):  
Domain Knowledge ◽  
Research Literature ◽  
Risk Exposure ◽  
Progression Rate ◽  
Cell Transplant ◽  
Care Model ◽  
Data Set ◽  
Patient Level ◽  
Oncology Care ◽  
The Impact

e18852 Background: Transferring financial risk from payers to providers to align incentives is central to value-based payment (VBP) reform, including Medicare’s Oncology Care Model (OCM). We simulated the impact of selected cancer- and patient-level factors on providers’ risk in OCM for multiple myeloma (MM), due to its clinical complexity. We hypothesize that risk exposure is sensitive to factors extrinsic to the OCM methodology, including clinical phenotype, disease state and progression rate. Methods: Simulation was used to address omitted variable bias in payer data. We developed 9 key clinical MM scenarios to examine provider risk, based on conceptual frameworks that included patient- and cancer-level factors. The model was parameterized using the Medicare limited data set, research literature and domain knowledge. Twenty factors were varied for each model, e.g. age, autologous stem cell transplant (ASCT). Results: Simulations results showed MM risk for providers depended highly on cancer and patient level factors (see table). For example, high-risk patients were on average $21.5K over target while undergoing ASCT (despite risk adjustment for ASCT) and $18-28K under target for follow on maintenance (maint.) episodes. Conclusions: Provider exposure to risk in OCM is highly sensitive to factors at the cancer and patient level. The distribution of clinical phenotypes, state of disease, and rate of disease progression can significantly impact risk exposure for providers in OCM. New methodologies that model risk in more clinically granular ways are needed to improve VBP in oncology. [Table: see text]

Potential Winners and Losers: Understanding How the Oncology Care Model May Differentially Affect Hospitals

2021 ◽  
pp. OP.21.00050
Author(s):  
Joel E. Segel ◽  
Eric W. Schaefer ◽  
Nicholas G. Zaorsky ◽  
Christopher S. Hollenbeak ◽  
Haleh Ramian ◽  
...  
Keyword(s):  
Medical School ◽  
Care Model ◽  
For Profit ◽  
Medicare Data ◽  
Higher Ed ◽  
Oncology Care ◽  
Ed Visits ◽  
Breast And Prostate Cancer ◽  
Expected Mortality ◽  
Rural Patients

PURPOSE: With the introduction of the Oncology Care Model and plans for the transition to Oncology Care First, alternative payment models (APMs) are an increasingly important piece of the oncology care landscape. Evidence is mixed on the Oncology Care Model's impact on utilization and costs, but as policymakers consider expansion of similar models, it is critical to understand the characteristics of hospitals that may be differentially affected. METHODS: We used 2007-2016 SEER-Medicare data to identify patients with breast and prostate cancer receiving chemotherapy, endocrine therapy (breast), or androgen deprivation therapy (prostate). For each hospital, we calculated 6-month expected mortality, emergency department (ED) visits, inpatient admissions, and costs, all commonly collected APM outcomes. After calculating observed-to-expected rates for each outcome by hospital, we estimated the association between observed-to-expected rates and characteristics of each hospital to understand hospital characteristics that might be associated with higher- or lower-than-expected rates of each outcome. RESULTS: Hospitals with > 15% rural patients had significantly higher-than-expected mortality (0.31 points higher, P < .001) and ED visit rates (0.10 points higher, P = .029) as well as significantly lower costs (0.06 points lower, P = .004). Hospitals unaffiliated with a medical school also experienced significantly higher-than-expected mortality and ED visits. Hospitals eligible for disproportionate share hospital payment experienced significantly higher ED visits but lower costs. For-profit hospitals experienced higher-than-expected mortality. CONCLUSION: Rural hospitals and those unaffiliated with a medical school may require special consideration as APMs expand in oncology care. Designated cancer centers and larger hospitals may be advantaged.

Product Variability Risks and Robust Design

1994 ◽  
Vol 208 (1) ◽  
pp. 9-19 ◽  
Author(s):  
K G Swift ◽  
A J Allen
Keyword(s):  
Quality Control ◽  
Robust Design ◽  
General Model ◽  
Best Practice ◽  
Quality Evaluation ◽  
Evaluation Methodology ◽  
Design For Manufacture ◽  
And Performance ◽  
Competitive Products

The design of a product largely predetermines its cost and quality, and there are therefore limits to the benefits that can be obtained by the application of best practice in manufacturing and quality control. The paper introduces a general model of design for quality and describes a systematic quality evaluation methodology to aid the development of quality competitive products. The application and performance of the methodology are described and its integration with techniques in design for manufacture and assembly is discussed.

Centers for Medicare & Medicaid Services' Oncology Care Model: Delivering Higher Value Cancer Care

2017 ◽  
Vol 101 (5) ◽  
pp. 569-571 ◽  
Author(s):  
LK Mortimer ◽  
LM Strawbridge ◽  
EW Lukens ◽  
A Bassano ◽  
PH Conway ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Model ◽  
Oncology Care

scholarly journals Exploring the Efficacy of Facebook Groups for Collective Occupant Learning About Using Their Homes

2017 ◽  
Vol 61 (7) ◽  
pp. 757-773 ◽  
Author(s):  
Magdalena Baborska-Narozny ◽  
Eve Stirling ◽  
Fionn Stevenson
Keyword(s):  
Urban Communities ◽  
Collective Efficacy ◽  
Best Practice ◽  
Evaluation Studies ◽  
Group Development ◽  
High Rate ◽  
Residential Developments ◽  
And Performance ◽  
Context Specific ◽  
Quality Learning

Using Facebook Groups to connect otherwise anonymous people that live in a single urban development is a relatively new phenomenon. Within residential developments, there are a number of common comfort, management, and performance issues experienced by many isolated inhabitants that are identified through building performance evaluation studies. Facebook is a ubiquitous social network tool and powerful communication platform, particularly popular among young adults. This article explores the use of closed Facebook Groups in relation to collective learning about home use in two residential communities in the United Kingdom. Data were collected through longitudinal digital and physical visits to case study residential developments and to the Facebook Group sites. Group development, dynamics, and the quality of knowledge sharing is evaluated. Findings are presented in relation to home use learning, as it proved to be a vital theme of each Group’s activity. We propose that weak-tie urban communities can develop collective efficacy through communicating on a Facebook Group that enables quality learning based on reciprocal sharing of experiences and knowledge by its members. This helps tackle comfort issues experienced, lower the cost of living, and share bespoke, context-specific home use best practice. Strong engagement and leadership of group administrators limited to early stages of the Groups’ formation followed by high rate of activity by the majority of members was key. There was a clear overlap observed between social media narrative and the physical experiences of daily life, which helps support residents. The analysis suggests the positive effect of the learning environment created bottom-up would not be easily transferable to professional applications.

scholarly journals Promoting rational antibiotics prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

2019 ◽  
Author(s):  
Regina Poss-Doering ◽  
Martina Kamradt ◽  
Katharina Glassen ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Social Influence ◽  
Health Professionals ◽  
Best Practice ◽  
Care Providers ◽  
Self Reflection ◽  
Physician Health ◽  
Depth Analysis ◽  
Improvement Programs

Abstract Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. To foster understanding of the networks’ potential impact on antibiotics prescribing, data generated through surveys with physicians and non-physician health professionals were analyzed descriptively. Results : Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotics prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion: Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotics prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. .

scholarly journals Promoting rational antibiotic prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

2020 ◽  
Author(s):  
Regina Poss-Doering ◽  
Martina Kamradt ◽  
Katharina Glassen ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Social Influence ◽  
Health Professionals ◽  
Best Practice ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Self Reflection ◽  
Physician Health ◽  
Improvement Programs

Abstract Background Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing. Results Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotic prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

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