QIM20-127: A Team-Based Model to Promoting Hospice Utilization in High Risk Oncology Patients Through Individual Care Plan Development

Authors: Mohammad Khan DO, MSBSa, Benjamin Switzer DO, MHSA, MSa, Sarah Lee MDa, Joseph Hooley MBA, CPPSb, Christa Poole LISW-S, OSW-Ca, Girish Chandra Kunapareddy MDc, Ruth Lagman MDa, and Alberto Montero MD, MBa
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  • a Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, OH
  • | b Cleveland Clinic Foundation, Marymount Hospital, Garfield Heights, OH
  • | c Union Associated Physicians, Terre Haute, IN

Background: The need for individualized care plans for high-risk patients (pts) has become a paramount concern as new therapeutic advances continue to develop in medical oncology. With a lack of standardized referral criteria for hospice services, the role of these services is often limited despite evidence that they can increase survival times and decrease hospital utilization. Studies show that 30-66% of pts did not receive hospice or palliative services in the last month of life, with many enrolled < 3 days before their death. Data suggests that pts with hematologic malignancies are less likely to receive hospice care and experience shorter lengths of stay than those with solid tumors. We hypothesize that utilizing a multidisciplinary team to identify high-risk pts and create care plans assessing hospice eligibility will lead to increased referrals and increased length of hospice stay. Methods: An Interdisciplinary Care Team (ICT), as previously described (ASCO 2018, Abstract 6547), was formed to identify pts with high-utilization over a 60-day period. Meeting twice monthly, the team consisted of medical oncologists, nurses, care coordinators, and social workers. Patients actively treated for leukemia and with bone marrow transplant within 100 days were excluded. Using a team based approach, individualized patient care plans were generated with close communication with outpatient teams. Results: A total of 112 pts were followed over a period of 24 months. Study cohort included 60 pts that died with 40 pts dying from solid tumor malignancy and 20 dying from hematologic malignancy. In the solid tumor subset, 75% (30/40) enrolled in hospice, 53% (16/30) enrolled within 90 days of ICT meeting, 80% (24/30) had hospice stay > 3 days, and average length of hospice stay was 27 days (median 14.5). In the hematologic malignancy subset, 70% (14/20) enrolled in hospice, 64.2% (9/14) enrolled within 90 days of ICT meeting, 57.1% (6/14) had hospice stay for > 3 days, and average length of hospice stay was 9.3 days (median 4). Conclusions: Recognition of high-risk pts in conjunction with care plan formation by ICT may correlate with earlier enrollment to hospice and increased lengths of stay in hospice. This promotes more use of beneficial hospice care in this patient population. Continued development of interventions to optimize transition to hospice and palliative care are needed, however, particularly in the challenging cohort of malignant hematology patients.

Corresponding Author: Mohammad Khan, DO, MSBS
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