The Combination of Technology and Education as Change Agents for Improving Breast Cancer Quality Care

The Combination of Technology and Education as Change Agents for Improving Breast Cancer Quality Care

Authors: Amanda Hathaway, MD1; Carrie T Stricker, PhD, RN2; Karina I Halilova, MD, MPH1; Karen J Hammelef, DNP, RN2; Debra Wujcik, PhD, RN2; William N Dudley, PhD3; Diane Baldwin, RN4; Austin Cadden, MBA, MPH4; Margaret Sullivan, MS4; Gabrielle Rocque, MD1

1University of Alabama Birmingham (Birmingham, AL); 2Carevive Systems, Inc. (Miami, FL); 3Piedmont Research Strategies, Inc. (Greensboro, NC); 4Mitchell Cancer Institute (Mobile, AL)

Poster presented at SABCS 2016


Background

With rapid advances in research, clinicians find it challenging to remain current with evolving care guidelines and to implement current national quality standards (NQS) relevant to breast cancer management. Adherence to NQS is driving reimbursement for cancer services, but clinical workflow processes and IT solutions are lacking to effectively document adherence. The Carevive Care Planning SystemTM (CPS), an evidence-based, patient assessment and care planning software and solution, is designed to close gaps in quality cancer care by seamlessly connecting clinical and patient-reported data with evidence-based algorithms, thereby allowing oncology programs to improve and document their adherence rates to quality care standards.

Design and Methods

  • 60 total non-metastatic breast cancer patients across 2 academic cancer centers (30 per site)
  • Eligible participants are planned to initiate chemotherapy treatment (≦2 medical oncology visits prior to enrollment)
  • Provider adherence to quality metrics is compared between the 30 historical controls (seen prior to study initiation) and intervention group
  • Two part study intervention includes:
  1. Provider participation in certified continuing medical education (CME) on evidence-based assessment, decision-making, and management strategies for breast cancer
  2. Use of the Carevive CPS with intervention subjects
    1. Subjects complete an electronic survey assessing current symptoms and concerns prior to their visit
    2. Subjects receive a provider-approved care plan including tailored recommendations for symptom management and referrals

Data collection is ongoing.  The primary analyses herein compares results of cases and controls at a single site and describes the differences between controls from two sites.

Assessment and Care Planning

Meeting the quality standards includes both assessment and subsequent addressing of the problem(s) in a documented plan of care.  Preliminary results for two quality metrics (emotional wellbeing and pain) indicate that:

  • Emotional wellbeing was poorly assessed at Site 1 (20%) but better addressed (33%) than at Site 2
  • 46% of control participants at Site 2 were assessed for emotional wellbeing, yet only 6% had their emotional wellbeing addressed
  • 100% of controls at Site 1 were assessed for pain, yet only 38% had their pain addressed (in a documented care plan)
  • Care plans for pain management were documented for 38% of patients at Site 1 and 50% at Site 2

Implications and Next Steps

Provider adherence to quality metrics for emotional well-being increased from pre- to post- intervention, suggesting effectiveness of the combined CME and Carevive CPS intervention.  Additionally,

  • Preliminary findings are incongruent within and across sites
  • Poor opioid induced constipation assessment for interventions and controls pre- and post intervention (6% vs. 18%), suggests opportunities exist for continued improvement in pain management assessment and care planning documentation

Meeting quality standards includes both assessing and subsequently addressing the problem(s) in a documented care plan.  Further analyses will be conducted once data collection is complete at both sites.

 The Combination of Technology and Education as Change Agents for Improving Breast Cancer Quality Care
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