Purpose: Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. Methods: We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. Results: Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. Conclusion: The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.

205 Background: Delays in access to treatment can cause anxiety and distress in patients with cancer. Time to treatment is increasing nationally, with retrospective analyses showing worse outcomes in patients with longer times to treatment initiation. It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation. We piloted a program for oncologic consultation within 1 business day in two subspecialty clinics and two network sites within our NCI designated comprehensive cancer center. Methods: Each pilot team created an implementation plan, with algorithms defining patients “eligible” for NDA. Generally, patients with a diagnosis or findings suggestive of cancer were eligible; full records were not required prior to the NDA visit. Interventions included adjusting physician templates and use of specific scripting to set expectations for patients prior to NDA visit. An institutional dashboard was created to display metrics--including new patient volume, % NDA visits, and reasons for non-utilization. Plan-Do-Study-Act cycles were completed every 2 weeks to assess data input/validity and address challenges. Patients seen via NDA completed a brief anonymous survey regarding their experience. Results: In 7 months, a total of 3107 new patients were seen across the 4 pilot sites, 900 (29.8%) of whom met “next day appropriate” criteria, and 370 (12%) of whom were seen via NDA. Uptake of NDA appointments was higher in patients with breast cancer. NDA patient satisfaction was extremely high, with 96% indicating that expectations were met or exceeded. Over half (56%) responded that a timely appointment was important when choosing a cancer center. The most common reasons patients were not seen via NDA included: specific provider requested (41%), specific date requested (23%), unavailable next day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that NDA appointments were inefficient with incomplete data, less time for clinical review, and increased burden due to last minute new patients; operational challenges included insufficient staffing and ensuring complete/accurate data collection. During 12/2019 – 2/2020, median time to first visit ranged from 17 to 36 days; median time to first visit decreased in 3 of the 4 pilot sites to 6-20 days 1 year later. Conclusions: Overall, 12% of patients were seen via NDA Success of this pilot required extensive effort to address change management and perceived barriers. Deployment in other disease teams and community sites is underway.[Table: see text]

166 Background: Barcode scanning of patient wristbands is a critical stop-gap to prevent administration errors. After EPIC go-live and the implementation of barcode scanning, we created 10 EPIC-based metric reports including scanning compliance. Prior to having reports, our clinical leadership relied on variable qualitative feedback on scanning rates. Our AIM was to reach 90% patient barcode scanning compliance by Feb, 2014 and 95% by Aug, 2014 across Smilow Cancer Hospital Care Centers of Yale-New Haven Hospital. Methods: To engage staff, we shared data on the importance of barcode scanning, compliance and related adverse event reports. Staff reported challenges with scanning patients. We engaged pharmacy leadership to rectify barcode mapping errors. Leadership shared the expectation that all patients would be scanned, that there would be spot checks to prevent workarounds, that staff would be accountable for their own performance and that of their peers, remediation plans for areas <90% compliant and use of a dashboard for employee and medication specific reports. Results: Monitoring, feedback, competition, and improved scanning equipment led to compliance increasing form 89% to 99%. Conclusions: Staff input, detailed reports and workflow review were needed for successful barcode scanning implementation. Staff knowledge that compliance was monitored, communicating improvement, and competition were required for incentive to change practice. Leaders encouraged a culture of safety by ensuring staff feedback was addressed and issues were resolved.Interdisciplinary teamwork between nursing, pharmacy, education and products was necessary to improve barcoding capability.EPIC-based metric reports can drive awareness of and improvement in quality metrics to ensure safe patient-care. [Table: see text]