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

• 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
• 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

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.

项目摘要/摘要 Medicare的五年肿瘤护理模型替代付款计划中的几乎所有提供商组 表达了减少癌症患者医院使用的目标，但很少有人实现这一目标。识别潜在的 使用诊断代码避免对癌症患者的医院护理很困难：取决于所使用的定义， 可以避免20-60％的医院就诊。主要的基于诊断代码的定义是化学疗法 门诊质量措施（OP-35），收集急诊室（ED）和住院 〜300次排放诊断代码分为10个可避免的条件。与类似的可避免医院措施不同 对普通患者的护理，OP-35尚未在临床上进行验证。而Op-35允许付款人比较 提供者组，两个问题限制了其对癌症提供者的有用性：首先，临床医生可能同意一些 OP-35条件（例如恶心/呕吐）在门诊或紧急护理环境中可以治疗，但其他人可以治疗 例如血液（血腥呕吐），很难在医院外评估。其次，Op-35 仅报告每个提供商组的医院就诊一百分之一 医院使用。基于初步工作，我们建议开发出可行的方案的分类 去医院护理（例如，患者需要非伴随手术；患者没有事先要求分类帮助） 因此，癌症提供者可以更好地理解如何经常减少这种情况，破坏性和昂贵的方面 治疗。我们将从肿瘤注册表，电子病历（EMR）和 区域健康信息交换数据，适用于代表所有癌症范围的潜水员样本 保险类型，包括未保险。该数据集将在100次中唯一链接> 75％的医院访问 德克萨斯州达拉斯的英里半径到该地区三个大型卫生系统的EMR。我们的目标是：目标1： 临床验证临床医院护理的基于诊断代码的措施（包括Op-35） EMR评论；将医院探访重新分类为可行的情况；并指定肿瘤学的新措施 紧急护理治疗条件。 H1：根据临床，大多数定义可避免的避免的OP-35将无法避免 审查。 H2：将在EMR中确定可操作的临床方案类别，并且可以进一步 由确定在紧急护理环境中可以治疗的条件的度量指定。目标2：前瞻性 验证我们可行的类别和新的肿瘤学紧急护理治疗条件对患者的测量 和ED临床医生使用放电后访谈。 H1：患者和ED临床医生将在很大程度上同意我们的 类别，有一些改进。目标3：对癌症提供者组进行全国调查以评估 我们的新定义在急性的情况下，我们的新定义可避免医院护理的可行性和适用性 护理管理功能。 H1：广泛的癌症提供者会发现我们的定义可行， 有用。我们研究的发现将提高质量测量和数据驱动的护理改善，并将 对于Medicare即将进行的增强肿瘤学模型支付计划的参与者特别有用。