A new study by the Association of Community Cancer Centers finds that very few hospitals are monitoring readmissions or following up with discharged patients.
The study of cancer patients’ transitions from inpatient to outpatient settings also found that while 85% of responding hospitals had a process to manage patients between-care settings, only 55% had a written transition policy, while only 3% had a specific transition policy that applied specifically to oncology patients.
In conducting the study, the ACCC "examined components of the care transition, including the adequacy and completeness of the medical record, medication reconciliation, and communication among providers – both within their own programs and between the two care settings," said ACCC President Al B. Benson III in a statement. Dr. Benson added, "Our goal was to understand the challenges involved in transitioning patients between settings and to identify best practices ensuring a smooth transition."
The study was conducted through two online surveys: one of oncology physician practices and the other for hospital-based oncology programs. About 100 participants completed surveys overall, according to the ACCC. Five hospital and four physician practices were selected as "exemplary" sites, based on a series of quality metrics.
Among the findings for hospitals: 93% had a process for contacting the patient’s oncologist when he or she was admitted for oncology-related treatment, but only 66% had procedures in place for making the contact when the patient was admitted with cancer as a secondary diagnosis.
Only 18% of hospitals contact oncology patients post discharge to confirm that follow-up appointments have been scheduled or met; 33% of hospital-based clinicians check, usually through a phone call to see how patients are doing more generally.
ACCC found that most hospitals and oncology practices "have fairly effective medication reconciliation procedures in place." But most hospitals also rely "almost entirely" on the patient or the family to tell them which drugs the patient is taking, the dose, and prescribed use – and do not confirm with the outpatient physician, the ACCC found.
Electronic health record (EHR) systems are making inroads but are generally accessible only by the admitting oncologist, not the community oncologist. Only 35% of hospitals with EHRs said they can transmit data to independent oncology groups, and only 32% automatically forward a discharge summary to independent groups.
On the outpatient side, the ACCC found that while oncologists infrequently are notified that their patients have been admitted, up to 60% of the responding oncology groups said they took proactive steps to determine admissions, by checking the EHR or hospital lists.
Fifty percent of the groups have designated staff to manage the transition, and more than 60% followed-up or made the post-discharge office appointment. But the ACCC found few groups have specific policies or checklists to help manage the transition.
Most groups (80%) said they conducted medication reconciliation and 75% had computerized order entry systems. Half use the systems to electronically transmit prescriptions to the pharmacist, but few can use computerized prescriber order entry to access external prescription databases, said the ACCC.
They also found that most oncology groups obtained the hospital medical records and discharge summaries, which they added to patient’s office chart. But the information was flagged for review in only about 25% of practices.
To a large extent, it seems that management of the patient transition is dependent on hospital-based EHR systems, said the ACCC.
The group highlighted other challenges such as hospitals and physicians competing for patients; the competition can sometimes impede communications during the transition. Also, the cost of managing a transition is not usually reimbursed.