Evaluating the Impact of Patient-Centered Oncology Care

The National Committee for Quality Assurance has worked with the National Coalition for Cancer Survivorship, the American Society of Clinical Oncology, Oncology Management Services, Independence Blue Cross, and RAND, as well as a broader multi-stakeholder advisory group, to define the Patient-Centered Oncology Care model. The purpose of this project was to pilot and evaluate this model. Specific research questions were:

1. Does Patient-Centered Oncology Care improve patient experiences and quality of care? Does it reduce undesirable events like emergency department visits and hospital stays?
2. How does adoption of Patient-Centered Oncology Care vary across a variety of practices and what factors affect adoption?

The demonstration occurred in oncology practices in southeastern Pennsylvania. Practices received implementation support during the 24-month demonstration period. They were evaluated using patient surveys, quality measures, and measures of emergency department and hospital use. Results from these practices were compared in two ways: 1) with their performance before they became oncology medical homes and 2) with other similar practices.

Study Overview

• Status: Completed
• Conditions: Neoplasms
• Intervention / Treatment: Other: Pilot of Patient-Centered Oncology Care

Detailed Description

Background. Advances in cancer treatment mean that a growing number of Americans are living with cancer and experiencing it as a chronic, long-term condition. National panels led by consumers have identified the need for improved cancer care in the areas of communication between providers and patients and their families, care planning, attention to nonmedical needs, care coordination and provision of evidence-based treatment. The patient-centered medical home (PCMH) model of care is being widely adopted as a way to provide accessible, proactive, coordinated care and self-care through primary care practices. During active treatment for cancer, the oncology practice is often the primary setting supporting the patient and coordinating cancer treatment. By implementing the patient-centered medical home model, an innovative oncology practice in Pennsylvania has been able to improve access and reduce emergency department visits and hospitalizations for its patients.

Objectives. Building on these recommendations and experience, the National Committee for Quality Assurance has worked with the National Coalition for Cancer Survivorship, the American Society of Clinical Oncology, Oncology Management Services, Independence Blue Cross, and RAND, as well as a broader multi-stakeholder advisory group, to define the Patient-Centered Oncology Care model. We sought PCORI support to pilot and evaluate this model. Specific research questions were:

1. Does Patient-Centered Oncology Care improve patient experiences and quality of care? Does it reduce undesirable events like emergency department visits and hospital stays?
2. How does adoption of Patient-Centered Oncology Care vary across a variety of practices and what factors affect adoption?

Methods. The demonstration occurred in 5 oncology practices in southeastern Pennsylvania. Practices received implementation support during the 24-month demonstration period. They were evaluated using patient surveys, quality measures, and measures of emergency department and hospital use. Results from these practices were compared in two ways: 1) with their performance before they became oncology medical homes and 2) with other similar practices. Patients, clinicians, and health plan leaders helped design the project, and disseminate results. The project used Patient Centered Outcomes Research Institute (PCORI) resources efficiently by building on ongoing efforts. Our evaluation consisted of a retrospective, pre-post study design with a concurrent non-randomized control group of 18 local practices for the utilization and patient experience outcomes. We used difference-in-difference regression models that accounted for practice-level clustering and used functional forms appropriate to the dependent variables. For quality, we compared baseline and follow-up pilot practice performance to national and regional benchmark performance data.

Patient Outcomes. People with cancer are seeking high quality, coordinated and supportive care. The Patient-Centered Oncology Model has the potential to address current gaps in cancer care.

• Study Type: Observational
• Enrollment (Actual): 125250

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington, District of Columbia, United States, 20005
      • National Committee for Quality Assurance

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of patients with cancer who received their cancer care from oncology practices. We attributed patients to the study practices (pilot or comparison practices) based on the plurality of office visits for cancer diagnoses. We used sensitivity analyses to investigate other attribution rules, such as the majority of such office visits.

Description

Inclusion Criteria

Patients:

• Diagnosis of cancer
• Receives care at a pilot or comparison oncology practice located in southeastern Pennsylvania that accepts patients with Independence Blue Cross health insurance

Exclusion Criteria:

• Any person that does not meet any of the inclusion criteria

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pilot Practices Patient Survey Cohort; Patients with any active drug therapy treatment for cancer receiving care at pilot practice in southeastern Pennsylvania	Other: Pilot of Patient-Centered Oncology Care; Patient-Centered Oncology Care addresses six domains: track & coordinate referrals, provide access and communication, identify and coordinate patient populations, plan and manage care, track & coordinate care, and measure and improve performance.
Comparison Practices Patient Survey Cohort; Patients with any active drug therapy treatment for cancer receiving care at comparison practice in southeastern Pennsylvania
Pilot Practices Utilization Cohort; Patients with an evaluation & management claim attributed to a medical oncology pilot practice in southeastern Pennsylvania	Other: Pilot of Patient-Centered Oncology Care; Patient-Centered Oncology Care addresses six domains: track & coordinate referrals, provide access and communication, identify and coordinate patient populations, plan and manage care, track & coordinate care, and measure and improve performance.
Comparison Practices Utilization Cohort; Patients with an evaluation & management claim attributed to a medical oncology comparison practice in southeastern Pennsylvania
Pilot Practices Quality Measures Cohort; Patients with a new diagnosis of cancer in the past two years	Other: Pilot of Patient-Centered Oncology Care; Patient-Centered Oncology Care addresses six domains: track & coordinate referrals, provide access and communication, identify and coordinate patient populations, plan and manage care, track & coordinate care, and measure and improve performance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Patient Experience From Baseline to Follow up	Patient experience survey composite scores were evaluated in the pilot practice group and in the comparison practice group during the intervention period and the follow-up period using a modified version of the cancer CAHPS patient survey. We calculated survey composite scores on a 0-100 scale using proportional scoring and the summated rating method based on the CAHPS macro.This method calculates the mean responses to each survey item in the composite, after transforming each response to a 0-100 scale (100 representing the most positive response on any given item response scale; 0 representing the least positive). For example, on a Yes/No response scale, if "Yes" represents the most positive response, then Yes= 100 and No = 0; on an Always/Usually/Sometimes/Never response scale, if "Always" represents the most positive response, then Always = 100, Usually = 67, Sometimes = 33 and Never = 0. A higher score means that practices were rated more positively for care on that item.	At baseline and 24 months follow up
Change in Quality of Care From Baseline to Follow up: Percentage of Patients Receiving Recommended Care	Quality measure performance rates were evaluated in the pilot practice group during the baseline period and the follow-up period. Data were abstracted from medical records for a sample of patients diagnosed with an invasive malignancy within previous 2 years and with at least 2 visits to the practice in the previous six months at baseline and at 36 months follow-up.	Two years prior to baseline and at 36 months follow-up
Change in Health Care Utilization From Baseline to Follow up	Per member per month hospitalizations, emergency department visits, primary care visits and specialist visits were evaluated in the pilot group and in the comparison group using insurance claims data during the baseline, start-up, intervention and follow-up periods.	Two years prior to baseline and at 36 months follow up

Collaborators and Investigators

• Sponsor: National Committee for Quality Assurance
• Collaborators: American Society of Clinical Oncology; RAND; Independence Blue Cross; National Coalition for Cancer Survivorship; Oncology Management Services
• Investigators: Principal Investigator: Sarah H Scholle, DrPH, MPH, National Committee for Quality Assurance

Study record dates

Study Major Dates

• Study Start: February 1, 2014
• Primary Completion (Actual): January 1, 2017
• Study Completion (Actual): January 1, 2017

Study Registration Dates

• First Submitted: January 31, 2014
• First Submitted That Met QC Criteria: April 8, 2014
• First Posted (Estimate): April 10, 2014

Study Record Updates

• Last Update Posted (Actual): March 9, 2021
• Last Update Submitted That Met QC Criteria: March 5, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Neoplasms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Advance Care Planning; Medical Oncology; Delivery of Health Care; Patient-Centered Care; Patient Care Management; Patient Care Team; Health Care Costs; Patient Care Planning; Evidence-based Practice
• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: IH-12-11-4383