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Online Training Tool Can Improve Pathway Adherence and Reduce Costs

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Key Points

  • An online training tool for physicians that uses hypothetical patient vignettes identifies areas of noncompliance with pathways and other areas in need of improvement.
  • Use of this tool can result in substantial cost savings to health-care systems.

A new educational tool for oncologists may enhance compliance with quality care standards and improve the value of cancer care, ultimately resulting in big cost savings for health-care systems, according to Karen Fields, MD, and colleagues from H. Lee Moffitt Cancer Center and Research Institute, Tampa, who described the new clinical tool and value initiative at a press briefing for 2013 ASCO Quality Care Symposium, to be held November 1 to 2 in San Diego (Abstract 255).

She estimated that for breast cancer treatment, the potential savings for 1 year would exceed $2 million at her cancer center.

“Health care is changing. It is no longer adequate for physicians and providers to simply demonstrate they have given high-quality care. It’s now important to demonstrate high-value therapy. Value is defined as providing high-quality care in a cost-effective way,” Dr. Fields said. “In preparation for value-based reimbursement models we developed clinical pathways, and our goal is 80% adherence.”

Monitoring pathway adherence via chart audits, however, is time-consuming and cost-prohibitive, so Moffitt Cancer Center devised an online tool for this. In July 2012, Moffitt launched the M-QURE (Moffitt Cancer Center—Quality Understanding Research and Evidence) Initiative, in partnership with QURE Healthcare, LLC, of San Rafael, California. The project has three aims: (1) measure and improve clinical performance, (2) increase compliance to evidence-based/cost-conscious cancer-care pathways, and (3) demonstrate value.

Case Vignettes

M-QURE does this by providing feedback regarding pathways adherence using virtual patients (Clinical Performance and Value [CPVTM] Vignettes) to measure the user’s adherence to pathways, determine diagnostic accuracy, and evaluate the clinician’s appropriate use of diagnostic tools. The vignettes are hypothetical patient scenarios that, for example, ask the provider to take a history of the virtual patient, order diagnostic workup, establish a diagnosis, and outline treatment strategies.

To date, 18 physicians and nurse practitioners have participated in the breast cancer vignettes. They will complete two vignettes every 4 months over the course of 2 years, for a total of 12 vignettes. Providers receive feedback regarding their CPV performance, showing areas where they are consistent with pathways or other standards of care, and opportunities to improve.

For selected performance items identified by the CPVs, the researchers audited medical records directly to determine if improving performance on the vignette model would translate into improving performance clinically. The results of the vignette tests are being evaluated for cost-effectiveness, based on the potential to reduce costs through the reduction of unnecessary testing and improved compliance with pathways.

Adherence Improves After Training

In the breast cancer pilot project, adherence to the various aspects of care varied widely. Compliance rates were highest for surgery (69%), radiation therapy (83%), and hormonal therapy (79%), but were low for diagnostic testing and appropriateness of chemotherapy.

Unnecessary diagnostic testing was noted for 50% of the providers, and inappropriate use of chemotherapy in 40%, she reported.

Financial Implications

“There are financial implications of improved pathway adherence using the CPV Vignettes,” Dr. Fields suggested. “We have looked at the two areas with the most deviation from pathways—diagnostic testing and chemotherapy pathways compliance—and have measured the costs for the year 2012 at Moffitt.”

Providers ordered an average of 1.6 additional diagnostic studies per patient, averaging $2,500 per test, and multiplied by 2,055 breast cancer patients at Moffitt in 2012. The researchers determined by a 30% improvement in this area would yield a reduction in annual charges of $1.6 million.

Similarly, a 40% compliance rate with chemotherapy pathways (consistent with the internal audit) cost Moffitt $20 million in 2012. A 30% improvement would yield a reduction in charges of $2.8 million, the researchers calculated.

Together, this exceeds $4.4 million in potential reductions in charges, Dr. Fields emphasized. “Considering the average reimbursement exceeds $2 million, this is real savings to payors and the health-care system.”

The researchers are now developing the tool for lung and gastrointestinal cancers.

Dr. Fields concluded, “We believe that measuring compliance can improve provider awareness of clinical standards, identify areas for quality improvement, and result in savings opportunities.

Olatoyosi Odenike, MD, of the University of Chicago, who moderated the press briefing, commented, “This illustrates that an online training tool can identify areas of deviation from evidence-based clinical practice. Providing feedback to providers leads to increased awareness of areas of deviation from the standard and can potentially motivate providers toward evidence-based practices. This can stimulate an increased quality of care and also result in substantial cost savings. Wider adoption of this sort of model could lead to a more sustainable care delivery model.”

G. Douglas Letson, MD, of H. Lee Moffitt Cancer Center, was the first author for the study.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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