Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction

Abstract

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.

Stratification of Length of Stay Prediction following Surgical Cytoreduction in Advanced High-Grade Serous Ovarian Cancer Patients Using Artificial Intelligence; the Leeds L-AI-OS Score

“…The calibration curves visually showed that the averaged predicted LOS probability of the models were consistent with the observed outcomes across different LOS risk groups from low to high. By demonstrating the utility of ML algorithms, we determined the impact of several variables, shown to be predictors of short-term outcomes in EOC patients [ 14 , 31 ].…”

“…It procures a surrogate for the technical complexity of a procedure. Surgical complexity is associated with prolonged LOS even with an established ERAS pathway in place [ 31 ]. Intrinsic non-modifiable predictors for LOS differ with operative complexity, and this should be considered when planning benchmarking and research across units.…”

Real-World Approaches to Quality Improvement in Oncology

“…It is clearly visible from these manuscripts that our field has evolved along the continuum from measurement to improvement. Several of the articles report evaluation of new models of care and provide some of the earliest information on the value of new models for early integration of palliative care, 2 creation of care networks, 3 and the oncology care model. 4 Others provide us with new approaches to quality measurement, 5 tools to assess barriers to quality improvement, 6 and pragmatic approaches to educate frontline providers on how to do quality improvement.…”

Engaging Community-Based Cancer Physicians: Experience of the Memorial Sloan Kettering Cancer Center Cancer Alliance

“…5 Nowhere is this more evident than in oncology, where community health systems have begun to partner with academic medical centers, which are attempting to extend their reach into the community setting, where 85% of cancer care is delivered. 6,7 Several NCI-designated Comprehensive Cancer Centers have established partnership and affiliation models, including the Duke Cancer Network, 8 MD Anderson Cancer Network, 9 and Fox Chase Cancer Center Partners Program. 10 Although each network's relationship model is unique, these programs typically provide community hospital partners with access to consultative services, treatment protocols, research, and clinical trials.…”