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.

108 Background: Recent focus has shown that oral chemotherapy is high risk for medical error. Our QOPI certification process identified that oral oncologic processes were marked by: lack of documentation in the EMR, patients receiving refills from third party pharmacies after prescription discontinuation, incorrect self-administration of medications due to lack of education, delivery delays, high copays, and underuse of available patient assistance programs. Methods: A multidisciplinary task force developed a program to expedite drug access, standardize consent, and ensure clinical support including education, adherence and toxicity monitoring. We expanded an existing health-system pharmacy to provide specialty services. Treatment protocols were created for every oral oncologic drug, which are routed to a clinical oncology pharmacist and the specialty pharmacy. Nursing and pharmacist verify all orders. Medication Assistance Program for copay support. Day 1, 5 and 21 pharmacist to patient calls. Multidisciplinary flow sheet documentation. Results: Today, 80% of our patients receive medication within 72 hours. Specialty pharmacists monitor toxicity even for patients whose prescriptions are filled by other pharmacies. Pharmacists have prevented more than 400 prescription errors. Today, monthly revenue before cost for the oral chemotherapy program is nearly than $4 million. The total revenue since initiation in February 2015 is over $44 million, yielding an approximately $9 million margin after costs. Funding through the medication assistance program exceeded $1 million thus far in 2016, with an average of 140 patients receiving assistance each month. Conclusions: A patient-centered multidisciplinary model integrating clinical, operational, financial, and IT resources optimized care for patients receiving oral oncologic therapy. This project transferred revenue from for-profit third party pharmacies to our non-profit health system, and revenue is used to provide enhanced education, monitoring, and patient assistance. Our collaborative improvement model can be adapted to many practice settings.

Methods: This qualitative study was part of a larger implementation study (ClinicalTrials.gov, Number: NCT02362204). During summer 2015, we conducted focus groups and semi-structured interviews in the thoracic cancer center of CHUV. Participants were purposefully sampled and included patients with lung cancer (n¼4) and HCPs from the MDT [physicians (n¼6), nurses (n¼5)], a social worker and the APNLC. Semistructured individual interviews were conducted to examine the perspectives of patients and the APNLC alike. Focus groups were employed to gather perspectives from the MDT. Data were analyzed using thematic content analysis.Results: Three main themes emerged describing the acceptability of the APNLC: "role identification," "rolespecific contribution" and "flexible service provision." Physicians and patients identified the specific APNLC role within the MDT. In particular, they valued specific contributions to continuity of care, psychosocial support and self-management of symptoms. Nurses perceived the APNLC role as overlapping with the traditional oncology nurse role. They were concerned about losing part of their traditional role. Flexibility in service provision was seen as strength of the APNLC role yet also posed organizational challenges related to the work-load. Conclusion: The new APNLC role appears to be wellaccepted by patients and physicians. Barriers identified during the implementation of the APNLC role were primarily related to intra-professional and organizational challenges. The intra-professional role tension could challenge effective role implementation. To maximize the acceptability of a new APNLC roleparticularly in countries that are in an early stage of APN role developmentwe recommend formalizing nursing role expectations, providing appropriate support/resources and promoting a national plan for APN accreditation and certification.