Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending

Colligan, Erin Murphy; Ewald, Erin; Keating, Nancy L.; Parashuram, Shriram; Spafford, Michelle; Ruiz, Sarah; Moiduddin, Adil

doi:10.1097/mlr.0000000000000795

Cited by 27 publications

(36 citation statements)

References 19 publications

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“…The most common cancer sites researched were colorectal cancer (n = 12 [86%]) and breast cancer (n = 6 [43%]). Ten studies assessed cost‐effectiveness: 8 found that PN programs were cost‐effective, and 2 did not observe cost‐effectiveness for the PN intervention . Five articles assessed only the cost of implementing a PN program and did not assess the return on investment (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, PN programs reduced future incident cancer diagnoses and improved timely diagnostic resolution, and substantial future cost savings were projected . PN also improved health care utilization: this included fewer hospitalizations, emergency department visits, and intensive care unit admissions and increased hospice enrollment in the last 2 weeks of life …”

Section: Resultsmentioning

confidence: 99%

“…Ten studies assessed cost-effectiveness: 8 found that PN programs were cost-effective, 128-135 and 2 did not observe cost-effectiveness for the PN intervention. 136,137 Five articles assessed only the cost of implementing a PN program and did not assess the return on investment 136,[138][139][140][141] (Table 1).…”

Section: Cost and Cost-effectiveness Of Pnmentioning

confidence: 99%

“…129,132 PN also improved health care utilization: this included fewer hospitalizations, emergency department visits, and intensive care unit admissions and increased hospice enrollment in the last 2 weeks of life. [133][134][135]137 Quality assessment…”

Section: Cost and Cost-effectiveness Of Pnmentioning

confidence: 99%

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The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

139

166

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Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost‐effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost‐effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow‐up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost‐effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost‐effectiveness and more rigorous reporting of study designs and results in published articles.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Cost and Cost-effectiveness Of Pnmentioning

confidence: 99%

Section: Cost and Cost-effectiveness Of Pnmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Bernardo

Zhang

Hery

et al. 2019

Cancer

139

166

View full text Add to dashboard Cite

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“…28 Finally, our intervention, which was intensely and narrowly focused on advance care planning, achieved substantively larger cost reductions. 46 Although we did not conduct a formal cost-benefit analysis, it is likely the reduction in health care spending exceeded the intervention's implementation costs. Our intention-to-treat analysis estimates that the intervention reduced total health care costs by approximately $31 660 per patient in the intervention resulting in an overall savings of $3 324 300 ($31 660 multiplied by 105 patients) during the 15-month study.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer

et al. 2018

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Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer

et al. 2019

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IMPORTANCE Emergency department visits and hospitalizations after starting systemic therapy for cancer are frequent, undesirable, and costly. A score to quantify the risk of needing acute care can inform decision-making and facilitate the development of preventive interventions. OBJECTIVE To develop and validate a score to predict early use of acute care after initiating systemic therapy for cancer. DESIGN, SETTING, AND PARTICIPANTS A retrospective population-based cohort study was conducted between July 1, 2014, and June 30, 2015. Patients with cancer were eligible if they started a new systemic therapy for cancer, regardless of line of therapy. A total of 12 162 patients in Southwestern Ontario, Canada, formed the development cohort and 15 845 patients in Northeastern Ontario formed the validation cohort. Data analysis was conducted from December 1, 2016, to August 10, 2019. EXPOSURES The Prediction of Acute Care Use During Cancer Treatment (PROACCT) score was created based on logistic regression in the development cohort. Combinations of cancer type and regimens were grouped into quintiles based on risk of needing acute care. The score was assessed in the validation cohort. MAIN OUTCOMES AND MEASURES At least 1 emergency department visit or hospitalization within 30 days after starting systemic therapy for cancer identified from administrative databases. RESULTS Among the 12 162 patients in the development cohort, 6903 were women and 5259 were men (mean [SD] age, 62.9 [12.6] years); among the 15 845 patients in the validation cohort, 9025 were women and 6820 were men (mean [SD] age, 62.9 [12.6] years). Use of acute care occurred within 30 days after initiation of systemic therapy in 3039 patients (25.0%) in the development cohort and 4212 patients (26.6%) in the validation cohort. Three characteristics predicted early use of acute care and formed the PROACCT score: combination of cancer type and treatment regimen, age, and emergency department visits in the prior year (C statistic, 0.67; 95% CI, 0.66-0.69; P < .001). Other characteristics including patient-reported symptoms did not improve performance. In the validation cohort, the PROACCT score was associated with use of acute care (odds ratio per point increase, 1.22; 95% CI, 1.20-1.24; P < .001), had a C statistic of 0.61 (95% CI, 0.60-0.62; P < .001), was reasonably calibrated, and provided net benefit in decision curve analysis. CONCLUSIONS AND RELEVANCE The PROACCT score predicted the risk of early use of acute care in patients starting systemic treatment for cancer and could be incorporated at the point of care to select patients for preventive interventions. Future studies should validate the PROACCT score in other settings.

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Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending

Abstract: The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.

Cited by 27 publications

References 19 publications

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

The efficacy and cost‐effectiveness of patient navigation programs across the cancer continuum: A systematic review

Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients With Cancer

Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer

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