The future of quality improvement in the setting of payment reform
Dr. Deborah Schrag put much of the research in context in her abstract discussion on oncology practice innovators. She advocated that the Gertner Model of Analytics should be employed in oncology quality of care research with the adoption of prescriptive analytics, to “make good care happen consistently, every time.” This model has been applied to other industries and must be considered in the oncology space, especially in the setting of payment reform. These reforms will call for a proactive care system with, as Dr. Schrag points out, care delivered not just in offices but through phone calls, navigators, and nurses to keep patients well, outside the traditional office visit, and to avoid adverse events. She notes that clearly ER visits and hospitalizations will continue to happen but the key question will be the percentage that are avoidable.
As an example, our own research from the University of Chicago Medicine presented at the symposium evaluated this question of “avoidability” with respect to terminal oncology ICU hospitalizations. It is estimated that 8% of oncology patients die in the ICU. These terminal ICU hospitalizations come at high cost and are associated with a reduced quality of life for patients and families. Using our Cancer Registry, we identified patients who died in our ICU in fiscal year 2013. Each of these hospitalizations was reviewed by an oncologist, intensivist, and hospitalist to determine the clinical avoidability of the terminal hospitalization. Physicians identified 47% of these terminal hospitalizations as clinically avoidable with different medical management. Dr. Schrag notes that the Centers for Medicare & Medicaid Services’ goal is to move quickly from a pay for volume to a pay for value system within the next few years. There will thus be increasing pressure on providers to design interventions to prevent these avoidable adverse outcomes.
Conclusion: Paragons of quality excellence
Forward motion in quality improvement will be delivered in part by focusing on positive deviance, those organizations that have succeeded in delivering high-quality care. The symposium ended with a presentation of exemplars in quality. Dr. Randall Holcombe and Dr. Robert Siegel discussed delivering quality care at a large academic, urban institution and in the community setting respectively. Dr. Holcombe and Dr. Siegel both emphasized the need for the institution to have an openness to quality improvement interventions. Dr. Holcombe noted that engagement and ethos are critical to quality improvement, and Dr. Seigel emphasized the need for a culture of innovation that was open to change and novel approaches. The conference wrapped up with attendees excited for the symposium next year and with an enthusiasm for confronting the quality improvement challenges of lovely babies and tooth brushes with rigorously tested, innovative interventions that enhance the value of care delivered to cancer patients.
Dr. Daly is the chief fellow in the section of hematology/oncology at the University of Chicago Medicine. He also serves as a director of Quadrant Holdings Corporation and receives compensation from this entity. Frontline Medical Communications is a subsidiary of Quadrant Holdings Corporation.
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