Analysis Identifies Attributes That Likely Contribute to High-Value Oncology Care

An analysis of positive deviant oncology care pinpointed the themes and attributes that likely contribute to high-value cancer care.

“Cancer care is complex, variably delivered, and usually conducted in an ambulatory setting by physician-led teams,” wrote the authors of the analysis, published in JAMA Oncology. “The complexity and variation in care delivery creates opportunities to identify attributes of ambulatory oncology practices that deliver high-value care, that is high-quality care at a relatively low total cost.”

The authors began their exploratory hypothesis-generating study with quantitative methods to identify positive deviant practices, or practices that ranked favorably compared with their peers on low mean total spending per treatment episode, and also scored highly on ambulatory quality measures. They then applied qualitative methods to identify potentially transferrable attributes of high-value care.

Value was quantified from high-quality oncology practices located near the US Pacific Northwest and Midwest with low mean insurer-allowed spending. Four positive deviant oncology practices and 3 oncology practices that ranked near the middle of the spending distribution were studied.

Two-day site visits were conducted between June 2, 2015 and October 3, 2015 to interview personnel and identify attributes of high-value care. Questions focused on care delivery methods, staff roles and functions, patient services provided, cultural norms, and diagnostic and surveillance testing used. A qualitative analysis was then performed to pinpoint attributes occurring uniquely or frequently in the practices.

The authors identified 13 distinct attributes that potentially affect care cost and quality:

• Palliative care incorporated early in the care arc and normalized
• Ambulatory rapid response provided for patients with an unstable condition
• Limits and consequences of treatment discussed
• Signs and symptoms proactively and continually assessed for the need for further assessment or triage leading to in-office or higher level of care
• Diagnostic and surveillance used conservatively
• Patient issues solved as a team
• Nurses used maximally to make care decisions and appropriate interventions
• Hospitalists used to maximize medical oncologists’ office-based time
• APP patient care roles maximized
• Electronic health records used effectively for communication and care coordination
• Physical location configured for informal consultation and collaborative work
• A single point of contact, usually a nurse, provided to help patients navigate oncology care system
• Patients with a high emotional burden or a lack of social support proactively identified, offered support services, and frequently and proactively reassessed

The attributes were grouped into 5 themes: Treatment planning and goal setting; support for the patient journey; care team organized so that members function at the highest level allowed by their competence and license; technical support and physical layout; and external context.

“Organizations facing increased pressure to lower healthcare spending and improve quality of oncology care can view this study as an additional source of insight, until readily transferable attributes of care are tested and available to inform more refined system designs,” concluded the authors.