Actionable categories of avoidable hospital care among adults with cancer

成人癌症患者可避免住院治疗的可行类别

基本信息

批准号：
10714125
负责人：
Arthur Seokjae Hong
金额：
$ 61.13万
依托单位：
UT SOUTHWESTERN MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10714125
关键词：
Accident and Emergency department Acute Address Admission activity Adult Agreement Ambulatory Care Applications Grants Automobile Driving Black race Cancer Patient Caring Categories Classification Clinic Clinical Code Community Hospitals Computerized Medical Record Cost aspects Data Data Set Diagnosis Diarrhea Disease Emergency Situation Emergency department visit Environment Feedback Future Goals Health Health system Hispanic Hospitals Immunotherapy Inpatients Insurance Interview Learning Link Malignant Neoplasms Managed Care Measurement Measures Medical Records Medicare Modeling National Comprehensive Cancer Network Nausea Nausea and Vomiting Oncology Organization and Administration Outpatients Pain Paracentesis Participant Patients Performance Procedures Provider Radial Reporting Sampling Sensitivity and Specificity Services Specific qualifier value Surveys Triage Uninsured Visit Vomiting Work acute care cancer care cancer diagnosis care delivery care providers chemotherapy clinically actionable cost data exchange data integration electronic structure hospital care improved payment programs prospective safety net success theories treatment effect tumor registry urgent care

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly all provider groups in Medicare’s five-year Oncology Care Model alternative payment program expressed a goal to reduce hospital use by cancer patients, but very few achieved this. Identifying potentially avoidable hospital care for cancer patients using diagnosis codes is difficult: depending on the definition used, 20-60% of hospital visits may be avoidable. The leading diagnosis code-based definition is the chemotherapy outpatient quality measure (OP-35), which collects emergency department (ED) and inpatient admissions with ~300 discharge diagnosis codes into 10 avoidable conditions. Unlike similar measures of avoidable hospital care for general patients, OP-35 has not yet been clinically validated. While OP-35 allows payers to compare groups of providers, two issues limit its usefulness to cancer providers: First, clinicians might agree that some OP-35 conditions (e.g. nausea/vomiting) are treatable in an outpatient or urgent care setting, but that others, such as hematemesis (bloody vomiting), would be difficult to evaluate outside of a hospital. Second, OP-35 reports only a percentage of hospital visits to each provider group, obscuring what exactly is driving avoidable hospital use. Based on preliminary work, we propose to develop a classification of actionable scenarios leading to hospital care (e.g. patient required non-emergent procedure; patient did not call for triage help beforehand) so that cancer providers can better understand how to reduce this frequent, disruptive, and costly aspect of treatment. We will assemble an integrated dataset from tumor registry, electronic medical record (EMR), and regional health information exchange data, for a diverse sample representing a range of cancers across all insurance types, including the uninsured. This dataset will identifiably link >75% of all hospital visits in a 100- mile radius of Dallas, TX, to the EMR of three large health systems in the region. Our aims are: Aim 1: Clinically validate diagnosis code-based measures of avoidable hospital care (including OP-35) with clinician EMR review; re-categorize hospital visits into actionable scenarios; and specify a new measure for oncology urgent care-treatable conditions. H1: Most OP-35 defined avoidable will not be avoidable based on clinician review. H2: Actionable categories of clinical scenarios will be identifiable in the EMR, and can be further specified by a measure that identifies conditions treatable in an urgent care setting. Aim 2: Prospectively validate our actionable categories and new oncology urgent care-treatable conditions measure with patients and ED clinicians using post-discharge interviews. H1: Patients and ED clinicians will largely agree with our categorizations, with some refinements. Aim 3: Conduct a national survey of cancer provider groups to assess the feasibility and applicability of our new definitions for avoidable hospital care, in the context of their acute care management capabilities. H1: A broad range of cancer providers will find our definitions feasible and useful. Findings from our study will advance quality measurement and data-driven care improvement, and will be especially useful to participants in Medicare’s upcoming Enhancing Oncology Model payment program.

项目概要/摘要医疗保险五年期肿瘤护理模式替代支付计划中的几乎所有提供者群体表达了减少癌症患者使用医院的目标，但很少有人实现这一目标。使用诊断代码对癌症患者进行可避免的医院护理是很困难的：取决于所使用的定义， 20-60% 的住院治疗是可以避免的。门诊质量衡量标准 (OP-35)，收集急诊科 (ED) 和住院患者的入院情况与可避免医院的类似措施不同，约 300 个出院诊断代码分为 10 种可避免的情况。 OP-35 尚未经过临床验证，而 OP-35 允许付款人进行比较。对于提供者群体来说，有两个问题限制了它对癌症提供者的有用性：首先，部落成员可能会同意，一些 OP-35 病症（例如恶心/呕吐）可以在门诊或紧急护理机构中治疗，但其他情况，例如吐血（血性呕吐），在医院外很难评估第二，OP-35。仅报告每个提供者组的医院就诊百分比，模糊了到底是什么导致了可以避免的情况根据前期工作，我们建议对可操作的主导情景进行分类。前往医院护理（例如患者需要非紧急手术；患者没有事先寻求分诊帮助）以便癌症提供者能够更好地了解如何减少这种频繁的、破坏性的和昂贵的方面我们将收集来自肿瘤登记、电子病历 (EMR) 和治疗的综合数据集。区域健康信息交换数据，代表各种癌症的不同样本保险类型，包括未投保的人该数据集将可识别地链接 100-75% 以上的医院就诊。德克萨斯州达拉斯市 1 英里半径范围内的三个大型卫生系统的电子病历我们的目标是：目标 1：与临床医生一起临床验证基于诊断代码的可避免住院护理措施（包括 OP-35） EMR 审查；将医院就诊重新分类为可行的方案，并指定新的肿瘤学措施； H1：根据临床医生的说法，大多数 OP-35 定义的可避免情况是无法避免的。 H2：可操作的临床场景类别将在 EMR 中识别，并且可以进一步进行。通过一项确定紧急护理环境中可治疗病症的措施来指定。目标 2：前瞻性。与患者一起验证我们的可操作类别和新的肿瘤学紧急护理治疗条件措施和急诊室顾客使用出院后访谈 H1：患者和急诊室顾客很大程度上同意我们的观点。目标 3：对癌症提供者群体进行全国调查以进行评估。我们对可避免的医院护理的新定义的可行性和适用性，在其严重的背景下 H1：广泛的癌症提供者会发现我们的定义是可行且可行的。我们的研究结果将推动质量测量和数据驱动的护理改进，并且将是有用的。对于 Medicare 即将推出的增强肿瘤模型付款计划的参与者特别有用。