The cost per patient of deviations from evidence-based standards of oncology care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6515-6515
Author(s):  
Arlene A. Forastiere ◽  
William A. Flood ◽  
Erik Yedwab ◽  
Vlad Kozlovsky ◽  
Elaine Whyler ◽  
...  
Keyword(s):  
Lower Cost ◽  
Quality Care ◽  
Practice Variation ◽  
National Standards ◽  
Evidence Based ◽  
First Order ◽  
Inappropriate Treatment ◽  
Oncology Care ◽  
Treatment Intent ◽  
The Cost

6515 Background: Practice variation contributes to the high cost of healthcare and wasteful spending; by contrast, adherence to evidence-based (EB) clinical guidelines is advocated to improve quality and potentially lower cost. We sought to estimate the average cost per patient associated with unjustified deviations from EB national standards for use of chemotherapy, supportive drugs, and radiotherapy. Methods: The ITA Partners/eviti, Inc. database of oncology treatment plans (TPs) reviewed for payers for adherence to national guideline recommendations (e.g. ASCO, ASTRO, NCI, NCCN Compendium, FDA) was used to calculate the variance in cost between submitted TPs with unwarranted deviations from EB standards and EB care. For prospective reviews, the final EB treatment given was known and for retrospective reviews, the variance was estimated based on the EB alternative with the lowest cost. AWP pricing was used to calculate chemotherapy and supportive drug costs, and Medicare pricing for radiotherapy. First order savings were calculated. An annual trend of 8% was applied from the mid-data period to 2013 (Milliman Client Report 2010). Results: From March 2009 to March 2012, a total of 2775 consecutive patients had TPs submitted and of these, 730 patients had unjustified, non-EB TPs. All cancer types, stage and treatment intent (curative, non-curative) were included. The cost of EB treatment was less than the submitted TP for 622 (85%) patients, more for 9 (1%), and zero (could not be taken due to payer plan definitions) for 99 (14%). Descriptive statistics for the cost per patient of non-EB TPs trended to 2013 showed: mean $25,579, median $13,882, standard deviation $40,958. Conclusions: In this unselected population comprising all cancers, 26% had TPs that did not conform to EB standards or could not be medically justified. Our conservative estimate of the average per patient overspend (first order) on inappropriate treatment validates the potential for quality care to lower cost and deliver huge value to patients, physicians, and payers. [Table: see text]

Reducing the Cost of Cancer Care: How to Bend the Curve Downward

2012 ◽  
pp. e46-e51 ◽  
Author(s):  
Thomas J. Smith ◽  
Bruce E. Hillner ◽  
Ronan J. Kelly
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
Cost Curve ◽  
Evidence Based ◽  
Curative Therapy ◽  
Appropriate Care ◽  
Insurance Costs ◽  
Oncology Care ◽  
The Cost ◽  
Care Costs

Overview: Health care and cancer care costs are rising unsustainably such that insurance costs have doubled in 10 years. Oncologists find themselves both victims of high costs and the cause of high-cost care by what we do and what we do not do. We previously outlined five ways that oncologists could personally bend the cost curve downward and five societal attitudes that would require change to lower costs. Here, we present some practical ways to reduce costs while maintaining or improving quality, including: 1) evidence-based surveillance after curative therapy; 2) reduced use of white cell stimulating factors (filgrastim and pegfilgrastim); 3) better integration of palliative care into usual oncology care; and 4) use of evidence-based, cost-conscious clinical pathways that allow appropriate care and lead to equal or better outcomes at one-third lower cost.

Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 43-43
Author(s):  
Nabeela Ratansi ◽  
Aimee Langan ◽  
Irene Blais ◽  
Erin Svara ◽  
Karla Houser ◽  
...  
Keyword(s):  
Best Practices ◽  
Performance Management ◽  
Capacity Planning ◽  
Best Practice ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Care ◽  
Practice Variation ◽  
Evidence Based ◽  
Gi Endoscopy

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.

Cost savings of biosimilars in oncology: A single institution experience.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 10-10
Author(s):  
Megan Mullalley ◽  
Whitney Mortensen ◽  
Phillip Barnette ◽  
Bradley Hunter ◽  
Terence Duane Rhodes ◽  
...  
Keyword(s):  
Single Dose ◽  
Lower Cost ◽  
Cost Savings ◽  
Financial Toxicity ◽  
Single Institution ◽  
Patients With Cancer ◽  
Medical Oncologists ◽  
Oncology Care ◽  
Intermountain Healthcare ◽  
The Cost

10 Background: Biosimilar medications have increasingly gained regulatory approvals in recent years. Numerous conditions in the fields of hematology, oncology, rheumatology, and endocrinology have a biosimilar treatment option available. Some biosimilar agents can be obtained at a significantly lower cost than reference medications. Methods: Intermountain Healthcare Oncology Pharmacy and Therapeutics (P&T) committee manages and maintains the formulary of accepted drugs. The committee consists of pharmacists, medical oncologists and oncology nurses. Biosimilar medications were approved in place of reference medications for the following: pegfilgrastim, bevacizumab, trastuzumab, and rituximab. Results: Annually, we administer about 6,450 combined doses of pegfilgastrim, bevacizumab, trastuzumab, and rituximab. Assuming 70% conversion from the reference medication to biosimilar agent, transitioning from the above listed reference medications to biosimilar would save an estimated $6.3 million annually (Table). This includes a $1.75 million savings from transitioning to rituximab alone. In addition, transitioning trastuzumab from a single dose vial to multi-dose vials is estimated to save an addition $730,000. Conclusions: Biosimilar agents can reduce the cost of oncology care to patients treated at our institution. We are utilizing biosimilar agents as part of our ongoing mission to decrease the financial toxicity of treatment for patients with cancer. [Table: see text]

scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

scholarly journals Implementing Delirium Prevention in the Era of COVID-19

2021 ◽  
Vol 79 (1) ◽  
pp. 31-36
Author(s):  
Nila S. Radhakrishnan ◽  
Mariam Mufti ◽  
Daniel Ortiz ◽  
Suzanne T. Maye ◽  
Jennifer Melara ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Quality Care ◽  
Tertiary Care ◽  
Cognitive Stimulation ◽  
Evidence Based ◽  
Care Hospital ◽  
Future Studies ◽  
Delirium Prevention ◽  
Prevention Model ◽  
Prevention Methods

Patients admitted with COVID-19 can develop delirium due to predisposing factors, isolation, and the illness itself. Standard delirium prevention methods focus on interaction and stimulation. It can be challenging to deliver these methods of care in COVID settings where it is necessary to increase patient isolation. This paper presents a typical clinical vignette of representative patients in a tertiary care hospital and how a medical team modified an evidence-based delirium prevention model to deliver high-quality care to COVID-19 patients. The implemented model focuses on four areas of delirium-prevention: Mobility, Sleep, Cognitive Stimulation, and Nutrition. Future studies will be needed to track quantitative outcome measures.

Advancing Excellence in Community Health Nursing Through Evidence-Based National Standards of Practice

2021 ◽  
Vol 52 (4) ◽  
pp. 168-175
Author(s):  
Emily Belita ◽  
Ruth Schofield ◽  
Genevieve Currie ◽  
Marie Dietrich Leurer ◽  
Aliyah Dosani ◽  
...  
Keyword(s):  
Community Health ◽  
National Standards ◽  
Evidence Based ◽  
Community Health Nursing ◽  
Standards Of Practice ◽  
Health Nursing

MODELING AND NUMERICAL SIMULATION OF AN ALGORITHM FOR THE INERTIAL SENSORS ERRORS REDUCTION AND FOR THE INCREASE OF THE STRAP-DOWN NAVIGATOR REDUNDANCY DEGREE IN A LOW COST ARCHITECTURE

2010 ◽  
Vol 34 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Lucian T. Grigorie ◽  
Ruxandra M. Botez
Keyword(s):  
Navigation System ◽  
Inertial Navigation System ◽  
Lower Cost ◽  
Inertial Sensors ◽  
Low Cost ◽  
Inertial Navigation ◽  
Noise Power ◽  
Integration Algorithm ◽  
The Cost ◽  
Miniaturized Sensors

In this paper, an algorithm for the inertial sensors errors reduction in a strap-down inertial navigation system, using several miniaturized inertial sensors for each axis of the vehicle frame, is conceived. The algorithm is based on the idea of the maximum ratio-combined telecommunications method. We consider that it would be much more advantageous to set a high number of miniaturized sensors on each input axis of the strap-down inertial system instead of a single one, more accurate but expensive and with larger dimensions. Moreover, a redundant system, which would isolate any of the sensors in case of its malfunctioning, is obtained. In order to test the algorithm, Simulink code is used for algorithm and for the acceleration inertial sensors modeling. The Simulink resulted sensors models include their real errors, based on the data sheets parameters, and were conceived based on the IEEE analytical standardized accelerometers model. An integration algorithm is obtained, in which the signal noise power delivered to the navigation processor, is reduced, proportionally with the number of the integrated sensors. At the same time, the bias of the resulted signal is reduced, and provides a high redundancy degree for the strap-down inertial navigation system at a lower cost than at the cost of more accurate and expensive sensors.

scholarly journals Economic analysis of the inclusion of thermoelectric ash in asphalt mixtures

2021 ◽  
Vol 10 (10) ◽  
pp. e28101018564
Author(s):  
Igor Nonato Almeida Pereira ◽  
Newton Paulo de Souza Falcão ◽  
Consuelo Alves da Frota
Keyword(s):  
Asphalt Concrete ◽  
Lower Cost ◽  
Electric Energy ◽  
Asphalt Mixtures ◽  
Raw Material ◽  
Stone Dust ◽  
Alternative Material ◽  
Good Technique ◽  
Materials Used ◽  
The Cost

The replacement of conventional materials used in hot asphalt mixtures with others of good technique and lower cost and environmental impact has motivated research in this area of knowledge in recent decades. The researches should be expanded in the scope of engineering, given that it contributes considerably to the transformation of spaces and raw material. In this context, thermoelectric ashes, which are residues from the production of electric energy, appear as an alternative to replace the stone powder input which contributes negatively to the environment considering that it comes from the blasting of rocks. This work aims to compare the cost of producing traditional asphalt concrete (reference) to asphalt compositions containing 5,15% of alternative material characterized by stone dust. There was a saving of R$ 0.21 per ton of AC machining, consisting of thermoelectric ash as a partial substitute (5.15%) for stone powder, which represents significant savings in a practical context.

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