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.

项目总结/摘要 几乎所有医疗保险五年期肿瘤护理模式替代支付计划的提供者群体 他们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。识别潜在 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%的医院就诊是可以避免的。基于诊断代码的主要定义是化疗 门诊质量指标（OP-35），收集急诊科（艾德）和住院患者的入院情况， ~300个出院诊断代码分为10种可避免的情况。不像类似的措施，避免医院 对于一般患者的护理，OP-35尚未得到临床验证。虽然OP-35允许付款人比较 提供者群体，两个问题限制了它对癌症提供者的有用性：首先，临床医生可能会同意， OP-35疾病（如恶心/呕吐）可在门诊或急诊环境中治疗，但其他疾病， 例如呕血（带血呕吐），在医院外难以评估。第二，执行部分第35段 每个提供者组只报告了一个百分比的医院访问，模糊了到底是什么驾驶可以避免 医院使用。在初步工作的基础上，我们建议制定一个可操作的方案分类， 送至医院护理（例如，患者需要非紧急手术;患者事先未寻求分诊帮助） 因此，癌症提供者可以更好地了解如何减少这种频繁的，破坏性的和昂贵的方面， 治疗我们将从肿瘤登记处、电子病历（EMR）和 区域健康信息交换数据，用于代表所有癌症的各种样本 保险公司，包括未投保的公司。该数据集将可识别地链接100- 2000年中所有医院就诊的>75%。 得克萨斯州达拉斯英里半径的范围内，到该地区三个大型卫生系统的EMR。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医院护理措施（包括OP-35） EMR审查;将医院就诊重新分类为可操作的场景;并指定肿瘤学的新措施 紧急护理可治疗的条件。H1：根据临床医生，大多数OP-35定义的可避免将无法避免 审查. H2：临床场景的可操作类别将在EMR中识别，并且可以进一步 通过确定在紧急护理环境中可治疗的条件的措施来指定。目标2：预防 与患者一起验证我们的可操作类别和新的肿瘤紧急护理可治疗条件 和艾德临床医生使用出院后访谈。H1：患者和艾德临床医生将在很大程度上同意我们的 分类，有一些改进。目标3：对癌症提供者群体进行全国调查， 我们对可避免的医院护理的新定义的可行性和适用性，在其急性 护理管理能力。H1：广泛的癌症提供者会发现我们的定义是可行的， 有用的.我们的研究结果将推动质量测量和数据驱动的护理改进， 对参加Medicare即将推出的增强肿瘤学模式付款计划的人特别有用。