Abstract P5-11-04: Technology as a change agent for improving breast cancer quality care
Authors: Hathaway A , Stricker C , Halilova KI , Hammelef KJ , Wujcik D , Dudley WN , Rocque G 
Published: March 2017

Background: With rapid advances in research, clinicians often struggle 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, is designed to close gaps in quality cancer care by marrying clinical and patient-reported data with evidence-based algorithms to help centers improve and document their adherence rates to quality care standards.

Methods: This study enrolled 30 non-metastatic breast cancer patients presenting to an NCI-designated comprehensive cancer center for no greater than their second medical oncology visit, and compared provider adherence to quality metrics for these patients with 30 matched historical controls who were seen prior to the study intervention. All were planned for chemotherapy treatment. The two part study intervention included 1) Provider participation in certified continuing medical education (CME) on evidence-based assessment, decision-making, and management strategies for breast cancer and 2) Use of the Carevive CPS with intervention subjects, each of whom who completed a electronic survey assessing current symptoms and concerns prior to their visit, and then received a provider-approved care plan including tailored recommendations for symptom management and referrals. The primary aim was to compare provider adherence to select quality metrics between historical controls (pre-test) and post-intervention subjects.

Analysis/Results:

Patient enrollment began in July 2015 and an earlier report of control data showed improved provider knowledge post-CME and opportunities to improve adherence. Median age and distribution of race, ethnicity, breast cancer stage, and HER2/ER status was not statistically different between the groups. Provider adherence to quality standards from pre to post-test is shown below:

Quality Standard MetricsQuality StandardNPrePostChi-squarepAssessed emotional well being6020%50%6.190.045Addressed emotional well being2133.3%93.3%8.510.004Pain quantified by second visit60100%100%N/AN/APain plan documented1137.533.3%&lt;10.90Opioid assesssed post treatment2791.0%100%1.510.22Opioid induced constipation assessed2718.2%9.3%&lt;10.33      

Conclusions:Provider adherence to quality metrics for emotional wellbeing increased from pre- to post- intervention, but did not for pain assessment and management. This was largely due to ceiling effect, but opportunities exist for continued improvement in pain management, at least in documentation. The Carevive CPS plus CME has the potential to allow institutions an patient-centered and user-friendly approach to both improve and document adherence to quality metrics.

Citation Format: Hathaway A, Stricker C, Halilova KI, Hammelef KJ, Wujcik D, Dudley WN, Rocque G. Technology as a change agent for improving breast cancer quality care [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-04.