Category: Professional Posters
Purpose: With the roll out of rule CMS-OP 35, oncology centers now face the challenge of reducing 30 day re-admissions. As reimbursements shrink, costs increase, and treatments become more complex, oncology pharmacies must evolve. Practice sites must strike a balance between the complexity of cancer treatment, high cost of therapy with reduced reimbursement, and the high level of patient acuity. The purpose of this study is to retrospectively evaluate if our symptom management program, which includes pharmacist led patient education, chart reviews, and phone call follow-ups, has been effective in reducing the number of emergency department (ED) visits and hospital admissions.
Methods: Our project is a single center, retrospective, chart review study. All patients over the age of eighteen who received chemotherapy between February of 2018 and February of 2019 at Indiana University Health Arnett Cancer Center were eligible. We implemented a new symptom management program that includes a preliminary chart review with pharmacist intervention for missing ancillary medications, in-depth pharmacist-led patient education, the creation of a Stoplight Handout to help patients determine if they need to alert the provider about a problem, and a follow-up phone call 48 hours after cycles one and two of chemotherapy. Our primary objective was to track the percentage of patients who visited the hospital within 30 days of chemotherapy for any of the eligible reasons. Per CMS-OP 35 guidelines, ED visits and hospital admissions must include at least one of the following as the reason for admission in order to be reviewed: anemia, pain, fever, sepsis, neutropenia, pneumonia, nausea, emesis, diarrhea, or dehydration. Any visits for other reasons were not included. Admissions and ED visits also had to have occurred within 30 days of when the patient last received chemotherapy. Secondary outcomes include decreasing adverse effects of chemotherapy and improving tolerance, improving patient knowledge of when to call about problems, and to quantify which patients may be at highest risk of visiting the hospital.
Results: We looked at 2072 chemotherapy encounters, 302 of which were for the purposes of baseline data. At baseline, our average monthly admission rate was 15.2%. Following implementation of our program, we had 197 hospital visits, and 49 of those patients were ultimately admitted. Our symptom management program has completed the education of 316 patients. Within a years’ time we called 310 patients for chemotherapy follow-up and gave 310 new patients the Stoplight Handout. The pharmacist chart review has resulted in approximately 140 prescriptions for ancillary medications such as ondansetron and dexamethasone. We have reduced our overall admission rate from 15.2% to 11.00%. We have reduced our admission rates enough to maintain full reimbursement from Medicare, and have – based on an average of 147 infusion encounters per month – prevented an estimated total of 72 hospital visits per year. We also observed that patients who are at high risk of needing hospital intervention have metastatic or advanced disease, or are receiving cycle one or two of chemotherapy. The most common reason for admission was overwhelmingly due to infectious causes, with approximately 75% being related fever, pneumonia, neutropenia, or sepsis.
Conclusion: In order to keep up with new regulations, our oncology center started a symptom management project which added several new methods of pharmacist intervention. These take place through up-front education and chart review, handouts, and post-chemotherapy phone calls. While we have not observed a statistically significant percentage reduction in hospital visits, our percentage has been reduced enough to maintain our full rate of reimbursement from Medicare. We are pleased that we are now providing better care with more knowledgeable patients, improved chemotherapy tolerance, and reduced visits to the hospital.