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Thom B, Sokolowski S, Abu-Rustum NR, Allen-Dicker J, Caramore A, Chino F, Doyle S, Fitzpatrick C, Gany F, Liebhaber A, Newman T, Rao N, Tappen J, Aviki EM. Financial Toxicity Order Set: Implementing a Simple Intervention to Better Connect Patients With Resources. JCO Oncol Pract 2023; 19:662-668. [PMID: 37319394 PMCID: PMC10424913 DOI: 10.1200/op.22.00669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/24/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Financial toxicity of cancer treatment is well described in the literature, including characterizations of its risk factors, manifestations, and consequences. There is, however, limited research on interventions, particularly those at the hospital level, to address the issue. METHODS From March 1, 2019, to February 28, 2022, a multidisciplinary team conducted a three-cycle Plan-Do-Study-Act (PDSA) process to develop, test, and implement an electronic medical record (EMR) order set to directly refer patients to a hospital-based financial assistance program. The cycles included an assessment of the efficacy of our current practice in connecting patients experiencing financial hardship with assistance, the development and piloting of the EMR referral order, and the broad implementation of the order set across our institution. RESULTS In PDSA cycle 1, we found that approximately 25% of patients at our institution experienced some form of financial hardship, but most patients were not connected to available resources because of our referral mechanism. In PDSA cycle 2, the pilot referral order set was deemed feasible and received positive feedback. Over the 12-month study period (March 1, 2021-February 28, 2022) of PDSA cycle 3, 718 orders were placed for 670 unique patients across interdisciplinary providers from 55 treatment areas. These referrals resulted in at least $850,000 in US dollars (USD) in financial aid in 38 patients (mean = $22,368 USD). CONCLUSION The findings from our three-cycle PDSA quality improvement project demonstrate the feasibility and efficacy of interdisciplinary efforts to develop a hospital-level financial toxicity intervention. A simple referral mechanism can empower providers to connect patients in need with available resources.
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Affiliation(s)
- Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefania Sokolowski
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Joshua Allen-Dicker
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy Caramore
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Doyle
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Patient Financial Services, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Francesca Gany
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison Liebhaber
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tiffanny Newman
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nisha Rao
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Johanna Tappen
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Social Work, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emeline M. Aviki
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Aviki EM, Chino F, Gany F, Caramore A, Doyle S, Liebhaber A, Newman T, Sokolowski S, Thom B. A multidisciplinary approach to operationalizing financial toxicity interventions: The MSK Affordability Working Group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2 Background: The financial toxicity (FT) of cancer is a concern for the healthcare system. Rising costs and increased cost-sharing result in high levels of financial burden, with negative implications for treatment adherence, quality of life, and financial well-being. As FT interventions must consider the interdependent systems of barriers patients face, this project highlights efforts toward developing and testing hospital-based FT interventions through the creation of the Memorial Sloan Kettering (MSK) Affordability Working Group. Methods: An interdisciplinary task force aimed to 1) characterize FT among patients receiving treatment at MSK; 2) identify areas for systemic change. Members included physicians, nurses, and social workers, and representatives from patient billing/financial services, health services research, and hospital administration and strategy. The team first conducted a review of medical records (2016 – 2018) to determine FT incidence and current practices for financial assistance uptake. Absent a formal FT screening, proxy measures defined FT as having bill payment issues, applying for financial assistance, or expressing financial concerns to Social Work, and we analyzed the percent of each category referred for assistance. Post-analysis program processes are also described. Results: Of 89,283 records reviewed, 22,187 (25%) patients experienced FT. Of 14,178 patients with payment issues, only 22% had been referred for financial assistance. As such, streamlining the assistance referral process became a priority, leading to the creation of an FT order set for providers to make direct referrals. From 3/2021-2/2022, 843 orders were placed, with $836,000 in co-pay assistance and $13,500 in essential needs assistance linked to the order set. The task force then met with hospital leadership to formally expand into an institutional working group, with organizational buy-in demonstrated through increased staffing and monetary support of patient-level pilot interventions. Stakeholders were engaged through presentations at departmental grand rounds and to individual disease teams. Operational and research efforts are now focused on systematic FT screening of patients, including validating a screening tool, developing nurse-led staff and patient education, assessing stakeholder feedback, and determining an appropriate screening cadence and workflow by disease type. Conclusions: With at least 25% of patients at MSK experiencing financial difficulties related to cancer treatment, it was, and remains, vital to develop systems-based interventions to proactively assess FT risk and refer to tangible resources. Planned future work includes implementation of universal FT screening with reflex referral to financial assistance, testing patient-level educational interventions, and developing policy/advocacy recommendations.
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Affiliation(s)
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Amy Caramore
- Memorial Sloan Kettering Cancer Center, New York, NY
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