Actionable categories of avoidable hospital care among adults with cancer

项目摘要/摘要 联邦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。潜在地识别 使用诊断代码对癌症患者进行可避免的医院护理是困难的：取决于所使用的定义， 20%-60%的就诊可能是可以避免的。主要的基于诊断代码的定义是化疗 门诊质量测量(OP-35)，收集急诊科(ED)和住院患者的入院情况 ~300个诊断代码排入10种可避免的情况。与可避免的医院的类似措施不同 对于普通患者的护理，OP-35尚未得到临床验证。而OP-35允许付款人比较 有两个问题限制了它对癌症提供者的作用：第一，临床医生可能会同意一些 OP-35疾病(例如恶心/呕吐)可以在门诊或紧急护理环境中治疗，但其他情况， 例如呕血(带血的呕吐)，在医院外很难进行评估。第二，OP-35 只报告了每个提供者群体的医院就诊比例，模糊了什么是确切可以避免的驾驶 医院使用。在前期工作的基础上，我们建议制定一种可行的情景分类，以 到医院护理(例如，患者需要非紧急程序；患者事先没有请求分诊帮助) 以便癌症提供者能够更好地了解如何减少这种频繁、破坏性和昂贵的方面 治疗。我们将从肿瘤登记、电子病历(EMR)和 区域卫生信息交换数据，以获取代表所有癌症的不同样本 保险类型，包括未投保的人。此数据集将可识别地将所有医院就诊的75%与100- 从德克萨斯州达拉斯半径1英里到该地区三个大型医疗系统的电子病历。我们的目标是：目标1： 与临床医生验证基于诊断代码的可避免医院护理措施(包括OP-35) 电子病历审查；将医院就诊重新归类为可操作的情景；并指定肿瘤学的新措施 紧急护理--可治愈的病症。H1：根据临床医生的说法，大多数被定义为可避免的OP-35将是不可避免的 复习一下。H2：可操作的临床方案类别将在EMR中识别，并可以进一步 由确定在紧急护理环境中可治疗的情况的措施指定。目标2：前瞻性 验证我们的可操作类别和新的肿瘤学紧急护理-可治疗条件与患者的衡量标准 和急诊医生在出院后进行面谈。H1：患者和急诊科临床医生将基本同意我们的建议 分类，并进行了一些改进。目标3：对癌症提供者群体进行全国性调查，以评估 我们对可避免的医院护理的新定义的可行性和适用性，在他们的急性 护理管理功能。H1：广泛的癌症提供者会发现我们的定义是可行的， 很有用。我们的研究结果将推动质量衡量和数据驱动的医疗改进，并将 对即将推出的联邦医疗保险增强肿瘤模型支付计划的参与者尤其有用。

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.