Expanding veteran treatment access points through Close To Me (CTM) infusion service.
Authors: Shields Jenna L , Valenti Erin R , Stone Andrea , Forse Frances J , Fox Brittney W , Rai Hema , Denk Lisa , Bachorski Denise , Genovese Dana , Kramer Jason , McWhirter Gina , Kelley Michael J. , Passero Vida Almario 
Published: June 2023

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Background: Diagnosing and treating more than 43,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) oversees the largest integrated providers of hematology/oncology services in the US. Within the VA, parenteral therapies are primarily offered at VA Medical Centers (VAMC) in urban areas, often inaccessible to rural patients. Travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment regimens. To resolve these challenges, NOP launched the Close to Me (CTM) infusion service. The service seeks to reduce travel time for patients, improve VA care continuity, and increase access points to patient-centric care by administering treatments utilizing the network of VA Community Based Outpatient Clinics (CBOC). Methods: In the CTM CBOC infusion service select medications are compounded at the main VAMC, then transported via a registered nurse to the surrounding CBOCs for administration. Eligible patients must be established with a VA hematologist/oncologist and tolerated 1 cycle of treatment at the VAMC. Patients are assessed via telehealth prior to each treatment at the CBOC. Patient drive miles saved was calculated by subtracting the mileage between the patient’s home address and the CBOC from the patient’s home address and the VAMC, then multiplied by number of treatment visits at the CBOC. Medication cost avoidance was calculated by subtracting the VA purchase price from the 2023 published Centers for Medicare and Medicaid Services reimbursement rates, then multiplied by number of treatments received at the CBOC. The first CTM CBOC clinics were opened within the Minneapolis VA Health Care System in October 2021, followed by the VA Pittsburgh Healthcare System in June 2022. Results: From October 2021 through December 2022, 373 unique patients were treated within CTM CBOC clinics for a total of 532 patient visits. The CTM infusion service resulted in 43,249 patient drive miles saved and 813,352 in medication cost avoidance. No medical emergencies were reported during CTM CBOC treatments. One medication was discarded without use due to damage during shipping. One compounded product was not used due to change in patient status. One patient was non-adherent with treatment appointments on two occasions resulting in an overall 99.6 % treatment adherence. Conclusions: The CTM infusion service optimizes current VA infrastructure to increase access points to hematology/oncology treatment, reduce travel burden for patients, increase treatment appointment adherence and reduce medication cost expenditures. To facilitate expansion of this successful service, NOP has provided funding and support to 11 additional VAMCs to implement one of the CTM solutions including CBOC, mobile infusion unit or home infusion. A comprehensive implementation toolkit was developed to encourage the independent adoption of this service at appropriate locations across VA.