Evaluating a New Patient-Centered Approach for Cancer Care in Oncology Offices

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What was the research about?

In this study, the research team tested a patient-centered approach to care at offices where oncologists treat patients. Oncologists are doctors specially trained to treat patients with cancer. The approach included

• Care that focuses on the whole person, including the patients’ goals, ability to care for themselves, and cultural and language needs
• Easy access to care, such as same-day appointments and quick responses to questions after office hours
• Better communication with patients and caregivers about test results, medicines, or care plans
• Coordinated care between patients and their oncologists, primary care doctors, and other doctors

The research team tested the patient-centered approach at five oncology offices. The study compared this approach to usual care at 18 other offices. The team wanted to learn how the patient-centered approach affected patients’ doctor visits, hospital stays, and experiences with care.

What were the results?

Doctor visits and hospital stays. Compared with patients at offices with usual care, patients at offices using the patient-centered approach

• Went to see specialists (such as their oncologist and radiologist) more often
• Saw their primary care doctor, went to the emergency room, or stayed in the hospital about the same number of times as the usual care group

Patient experiences. Compared with patients at other offices, patients at offices using the patient-centered approach had

• Better experiences making shared decisions with their doctor
• Worse experiences accessing care
• Worse experiences giving information to and getting information from their doctor
• Similar experiences talking with their doctor about their feelings
• Similar experiences managing their own care

Quality of care. Compared to the beginning of the study, patients at offices using the patient-centered approach were

• More likely to have their symptoms correctly assessed and their care managed
• Less likely to have a doctor follow-up about problems they talked about in a visit

Who was in the study?

Patients in the study got care at 23 oncology offices in Pennsylvania. The average age of patients was 61. On average, 65 percent of patients were female. In addition, an average of 87 percent of patients were white, and 11 percent were black. Another 1 percent were Asian, and 1 percent were other races.

What did the research team do?

The research team compared data from patients at the 5 offices using patient-centered care with the 18 offices using usual care. The team compared the data before the start of the study and again after the five offices started using the patient-centered approach.

Using health insurance records, the team looked at doctor visits, hospital stays, and emergency room visits for 30,843 patients across all the offices. The team also asked 715 patients at the start of the study and 437 patients at the end about their experiences with care. Next, the team looked at medical records to see if the quality of care changed from the beginning of the study to the end.

During the study, a group of patients and patient advocates gave advice to the research team on the study design and the patient-centered approach.

What were the limits of the study?

The research team did not select the five offices that offered to provide patient-centered care by chance. The findings may reflect things about the offices other than whether they used the new patient-centered approach. For example, patient traits were different between the two groups of offices. Also, the team didn’t know about other approaches for patient-centered care that the offices may have been using. The team can’t say how important the findings are to the actual quality of the care that patients received.

Future research could assign offices by chance to use the patient-centered care approach or continue with usual care. Studies could also test other approaches that support patient-centered care at oncology offices.

How can people use the results?

Researchers can use these results as they look for ways to improve patient care at oncology offices.

Objective

To assess whether using patient-centered standards of care affects healthcare utilization or improves patient experience and clinical quality of care at oncology offices

Study Design

This quasi-experimental trial evaluated whether implementing new patient-centered standards for medical care in oncology practices affected healthcare utilization or improved patient experiences and clinical quality of care when compared with usual care. The National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home and Patient-Centered Specialty Practice models provided the basis for the new standards. The goal of the standards is to deliver more accessible, coordinated, team-based oncology care. Patient advocates and patients gave input to the research team on study design, planning, and implementation of the standards.

Five oncology practices in Southern Pennsylvania volunteered to implement the new standards and received training and technical assistance for the implementation. The research team compared outcomes from the 5 practices with outcomes from 18 practices in the same community that did not implement the new standards. The team used insurance claims to determine hospitalizations, emergency department (ED) visits, and primary care physician (PCP) and specialist office visits per patient per month at baseline, at start-up of implementation, during intervention implementation, and during follow-up. A cross section of the patient population received the CAHPS® Cancer Care Survey at baseline and during follow-up to assess their cancer care experiences. The team also compared the clinical quality of oncology care in the intervention group to national benchmarks at baseline and follow-up.

The average age of patients in the study was 61. On average, 65% of patients were female. In addition, an average of 87% of patients were white, 11% were black, 1% were Asian, and 1% were other races.

Results

Healthcare utilization. From baseline to follow-up, specialist visits increased in the intervention group compared with the practices providing usual care (p=0.03). The research team found no differences in hospitalizations, ED visits, or PCP visits between patients at the practices that applied the new standards and those providing usual care.

Patient experiences. For some domains, patients reported better experiences with cancer care at practices using the intervention. For other domains, patients reported better experiences at practices providing usual care.

• Patients’ experiences with shared decision making were significantly better at intervention practices than at practices providing usual care (p=0.013).
• Patients’ experiences with access to care (p<0.001) and exchanging information with providers (p=0.013) were significantly better at practices providing usual care than at intervention practices.
• Patients’ experiences with effective communication and patient self-management were similar at intervention practices and practices providing usual care.

Clinical quality. In the intervention group, clinical quality of care was related to symptom assessment. In addition, care planning improved by more than 10 percentage points at follow-up and exceeded the national benchmark. However, the research team found a decline in the clinical quality of follow-up for problems identified during care.

Limitations

Because the research team did not randomize practices to the intervention, the study results may not have been directly related to the implementation of the new care standards. Patient characteristics differed between the intervention practices and practices providing usual care, which could have biased the results. The research team did not assess clinical quality results for the comparison group. The importance of the observed improvement in clinical quality results for the intervention group is not clear.

Conclusions and Relevance

Pilot oncology practices implementing the NCQA’s new patient-centered oncology standards of care had an increase in patients’ use of specialty care compared with practices that did not implement the standards, but there was no impact on patients’ PCP visits, ED use, or hospitalizations. Patients in the intervention practices also reported better experiences with shared decision making, but less access to care and less information exchange with providers than patients in the practices providing usual care. The improved performance observed in clinical quality measures addressing care planning and assessment is a potentially important impact of the standards.

Future Research Needs

Future research could randomly assign practices to apply the new standards to reduce possible selection bias. Additional studies could identify the specific components of effective methods of goal setting, care planning, and care coordination that lead to improved outcomes for patients.