Impact of a Quality Improvement Initiative in Ovarian Cancer in 2 Large US Hospital Systems Poster ID

11065Robert L Coleman, MD, FACOG, FACS1; Thomas E Lad, MD2; Jeffrey Carter, PhD3; Cherilyn Heggen, PhD3

1. US Oncology Research, Houston, TX; 2. Cook County Health and Hospitals System, Chicago, IL; 3. PRIME Education, LLC, Ft. Lauderdale, FL

Methods

PRIME partnered with 2 systems: a large public hospital system and a large independent oncology practice network.

Patients with recurrent OC and their providers completed surveys assessing beliefs and experiences with OC care.

In each system, OC care teams participated in feedback-focused grand rounds to develop team-based action plans guided by survey and chart review findings.

To further disseminate findings, expert faculty shared research insights, lessons learned, and best practices for evidence-based OC care in a national live webinar and enduring webcast.

Follow-up chart reviews were conducted 6 months following the system education to assess changes in documentation and practice behavior.

Background

Maintenance therapy (MT) with poly(ADP-ribose) polymerase (PARP) inhibitors has changed the treatment landscape for ovarian cancer (OC). The objectives of this quality improvement (QI) initiative were to:• Evaluate system-wide, team-based strengths and areas for

improvement in the real-world treatment of women with recurrent OC

• Support team-based action plans for improving the delivery of evidence-based, patient-centered care, including the effective use of shared decision-making (SDM)

• Disseminate best practices in the use of PARP inhibitors as MT to a national audience of oncology providers

• Evaluate the value of a QI initiative in identifying and addressing system-based challenges in quality care

Electronic medical records (EMRs) of patients with recurrent OC were retrospectively reviewed to assess documented practice patterns. Preliminary baseline survey and EMR review findings were reported at ASCO 2020.1

Conclusions

• Patients with OC and their care teams prioritize different treatment considerations; patients are more likely to report the need for better disease/treatment education and better counseling for anxiety, distress, and fertility preservation.

• Baseline EMR audits demonstrate low rates of documented molecular testing, recurrence and adverse event monitoring, MT utilization, and SDM.

• Feedback-focused education is an effective tool for informing team-based action plans, improving chart-documented practice behavior, and increasing provider confidence in the delivery of evidence-based care.

• Methods and findings from this QI study are relevant for the design of future interventions to improve the quality of care for patients with recurrent OC.

Reference 1. Coleman RL, et al. ASCO 2020. Abstract e19174. Disclosures This project was supported by an educational grant from TESARO. The supporter did not play a role in the study design or analysis, or in the decision to submit for presentation.

Patient Chart Reviews

• Patients aged > 18 years with biopsy-confirmed diagnosis of high-grade, recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer

• At least 2 visits with provider in previous 24 months

Baseline EMRs (N = 200)

Follow-up EMRs (N = 200)

Mean age (range) 66 years(40‒80 years)

62 years(30‒90 years)

Mean time since diagnosis (range)

3 years (1‒8 years)

3 years (1‒16 years)

Type of insurance

Medicare 57% 58%

Commercial 41% 40%

Medicaid 2% 2%

Stage

Stage 1‒2 37% 58%

Stage 3‒4 60% 37%

Not documented 3% 5%

Participant Demographics

Patient and Provider Surveys

Providers N = 35

Oncologist 60%

NP/PA 17%

Oncology nurse 17%

QI/risk management staff 6%

Mean years practicing in current system

7 years

Mean patients with OC seen monthly

10 patients

Patients N = 21

Mean age 58 years

Time since diagnosis

< 1 year 5%

1‒4 years 65%

4‒7 years 15%

7‒10 years 0%

> 10 years 15%

30% 33%54%

76%95%

63%

BRCA1/2 testing Recurrence monitoring Adverse eventmonitoring

Baseline EMR (N = 200) Follow-up EMR (N = 200)

Fig 3. Molecular Testing and Patient Monitoring

39%

4%

47%

13%

Received any MT Received PARP inhibitor as MT

Baseline EMR (n = 137) Follow-up EMR (n =112)

Fig 4. MT in Patients Who Responded to Platinum-Based Chemotherapy

32%43% 44%

76%65%

73%

Asked patients abouttreatment goals

Asked patients abouttreatment expectations

Asked patients aboutconcerns and fears

Baseline EMR (N = 200) Follow-up EMR (N = 200)

Fig 5. Shared Decision-Making Practices

Survey Findings: Patient-Provider Discordances

NP = Nurse Practitioner; OC = Ovarian Cancer; PA = Physician Assistant; QI = Quality Improvement

P < .001 P < .001

P = .138

P = .170

P = .005

P < .001 P < .001 P < .001

Feedback-Focused Grand Rounds: Action Plans for Improving Care

Dissemination of Best Practices: Provider Beliefs and Confidence

Fig 1. Provider Perceptions and Patient Reports of Patients’ Key Considerations for Treatment

6%

21%

21%

30%

35%

49%

69%

94%

20%

40%

50%

45%

20%

25%

30%

80%

Patients (N = 21) Providers (N = 35)

Cost of therapy/insurance coverage

Treatment efficacy

Adverse events

Education/advice from care team

Quality of life

Fertility preservation

Anxiety about recurrence

Online education

Chart Findings:Documented Clinical Practice

80%

60%50%

25% 13% 25%

Disease andtreatment education

Anxiety/distresscounseling

Fertility counseling

Patients (N = 21)Providers (N = 35)

Fig 2. Provider Perceptions and Patient Reports of Patients’ Priorities for Improved OC Care

Fig 9. Provider Confidence Impact

After participating in the webinar/webcast, change from baseline in proportion of providers (N = 1,338) who reported at least moderate confidence in their ability to:

Differentiate among PARP inhibitors

Integrate PARP inhibitors into treatment plans for OC

Recognize and manage adverse events associated with PARP inhibitors

Fig 8. Provider Self-Reported Likelihood to Change Practice

After participating in the webinar/webcast, change from baseline in proportion of providers (N = 1,338) who reported:

Among all treatment lines, being mostly likely to recommend MT with PARP inhibitors after first-line treatment

50% Improve communication across members of the treatment team

35% Integrate supportive care measures into treatment plans

50% Facilitate access to distress screening, fertility counseling, and end-of-life counseling

Fig 7. Top 3 Priorities for Improving Patient-Centered Care

55% Integrate biomarker testing into treatment decision-making

50% Address uncertainty about whenand for whom MT is appropriate

Fig 6. Top 3 Priorities for Team-Based Action Plans

35% Monitor patients for disease progression and the need to adjust therapy

N = 20

42%P < .001

59%P < .001

50%P < .001

41%P < .001

N = 20