Enhancing personalized, evidence-based care for veterans with hepatocellular carcinoma (HCC): Insights from a team-based quality improvement initiative.

Abstract

531 Background: Hepatocellular Carcinoma (HCC) is a major health challenge among Veterans, necessitating a nuanced approach. This initiative compared patient and provider perspectives to tackle real-world challenges and improve care for Veterans. Methods: Between 10/2023-12/2023, 111 healthcare professionals (HCPs) treating HCC in federal settings and 283 patients with HCC (153 Veterans) completed surveys on practice patterns and challenges in care. HCPs attended audit-feedback sessions to review survey findings, assess site-specific challenges, and develop improvement action plans. Longitudinal follow-up surveys evaluated sustained practice changes. Results: Top HCP-reported barriers to care for Veterans were health literacy/mental health (41%) and transportation (36%). Moreover, 56% said all/most patients are discussed in tumor boards and 57% reported referring all/most patients for supportive care. Only 18% of HCPs had integrated the VA HCC Clinical Pathway into practice and 42% were unaware of it. Veterans were more likely than non-Veterans to have prior cirrhosis diagnosis (84% vs 64%); routine screening (87% vs 71%); and more than 2 hospitalizations since diagnosis (82% vs 55%) ( p < .001). Liver transplant was more frequent in non-Veterans (41% vs 12%) ( p < .001). Veterans found needing help from others (30%) and dealing with medicine side effects (24%) the most difficult parts of their diagnosis, while non-Veterans cited feeling bad (32%) and the cancer diagnosis itself (31%). Tethered surveys showed discordant findings between Veteran and HCPs on goals for treatment and timing of treatment initiation. For example, 65% of HCPs reported a 1-3 month wait from diagnosis to treatment while only 27% of Veterans agreed, with most selecting a longer timeframe due primarily to issues with insurance/cost of care (55%). To address gaps, HCPs implemented action plans which resulted in increased use of clinical pathways, more patients discussed at tumor boards, connecting patients with transportation resources and social services, and inclusion of navigators to streamline patient referrals. Conclusions: This QI initiative highlighted key gaps in individualized, evidence-based HCC care. By translating survey insights into targeted action plans, HCPs took concrete steps toward optimizing care. Findings underscore the need to streamline multidisciplinary collaboration and patient navigation to ensure timely, guideline-based care for Veterans. Strategies developed through this initiative offer a scalable model for improving HCC management in both federal and non-federal settings.