Demonstrating value: association of cost and quality outcomes with implementation of a value-driven oncology-hospitalist inpatient collaboration for patients with lung cancer

Abstract

The hospitalist model of care has gained favour in many hospital systems for the value, cost-effectiveness and quality of care that hospitalists provide. Hospitalists are experts in high-acuity medical problems of patients and they are intimately knowledgeable about hospital operations that enable efficiency of patient care. This results in tremendous cost-savings for institutions especially since hospitalists are also obligated to be involved in quality and practice improvement initiatives. The University of Texas MD Anderson Cancer Center employs oncology-hospitalists for many of their patients with cancer needing inpatient services. This physician team has expertise in both cancer-related and comorbidity-related reasons for hospitalisation. In September 2015, the thoracic and head and neck medical oncology team started a collaboration with the Oncology Hospitalist team whereby a proportion of patients with thoracic malignancies were directly admitted to hospitalists for inpatient care. To determine the value of this collaboration, a pre- and post- implementation study was done to compare quality outcomes such as readmission rates and length of stay (LOS) between the two groups. Adjusted outcomes showed that readmission rates were similar for both physician groups both at baseline and after implementation of the collaborative (p=0.680 and p=0.840, respectively). Median LOS was similar for both groups at baseline (4 days) and was not significantly different post-implementation (4vs5 days, p=0.07). The adjusted cost of a hospitalisation was also similar for hospitalist encounters and thoracic oncology encounters. This initial study showed that quality of care remained comparable for patients with lung cancer who were admitted to either service. With possibly shorter LOS but comparable readmission outcomes and adjusted cost for patients discharged from the hospitalist service, there is a strong value benefit for the implemented Thoracic Oncology-Hospitalist inpatient collaborative.

Preliminary evaluation of a new initiative to centralize colorectal cancer care during the COVID-19 epidemic in Shanghai, China: a retrospective study

“…These findings are consistent with prior research on a Veterans Affairs medical center, which showed that patients received increased quality of care, better access to care, and improved multidisciplinary treatment in CCCs (38). In addition, studies have shown that the MDT approach can improve the survival quality of patients with CRC and other types of tumors (39)(40)(41)(42). The model examined in the present study realized the accumulation of medical resources, achieved the standardization of diagnosis and treatment procedures, and subsequently strengthened the incentive mechanism.…”

Clinical and economic burden of pre‐emptive therapy of cytomegalovirus infection in hospitalized allogeneic hematopoietic cell transplant recipients

“…There could also have been misreporting or misclassification of ICD‐9 codes for CMV infection and HCT by the coding specialists and physicians, which may have caused underestimation or overestimation of CMV‐associated costs and clinical burden across the 19 cancer centers. Finally, the generalizability of the Vizient database could be another limitation as small number of studies utilized this method …”

The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery

“…The hospitalist model of inpatient care delivery is an accepted standard of care [1,2], and there are now numerous examples of hospitalists managing hospitalized patients with cancer, with similar outcomes to those cared for on medical oncologist-led services [3][4][5][6][7]. The perceptions of oncologists about inpatient cancer care delivery and the hospitalist model are unknown.…”