Lung cancer navigation pilot: Preliminary results of nurse outreach support for lung cancer patients enrolled in the EOM.

Abstract

e13580 Background: Oncology practices struggle with reducing unnecessary ED visits and hospitalizations. This is an important quality metric for EOM, MIPS, and many commercial plans. Practices can earn greater shared savings by reducing hospital and ED utilization. Objective: Determine whether nurse outreach can reduce admissions and emergency department (ED) visits among high-risk lung cancer patients enrolled in the EOM. About 2K lung cancer patients enrolled in EOM are attributed to TxO. This is the 2 nd highest group after breast cancer and represents 20% of our EOM population. Methods: Program began in September 2024. Patients were selected for the pilot using the list of EOM patients and the APEX report (an advanced analytic model which predicts 90-day mortality risk for patients with metastatic cancer). A mix of low to very-high patients were selected, enrolling moderate to very high-risk patients first until the case load of about 100 patients per navigator was reached. Calls ranged from weekly to every 4 weeks depending on patient need and treatment/OV schedule. Advance Care Planning introduction was promoted, with the goal to introduce at the initial call if appropriate or at least by the third call. Patients were removed (disenrolled) once they meet one of the following criteria: Death/Hospice; Transfers care outside TXO or decision to stop treatment and follow-up; EOM episode ends and no future treatment planned; Patient unresponsive to phone calls after 5 attempts. Results: Hospital and ED Utilization and re-visit rates were better for the Outreach group compared to the rest of the EOM Lung Cancer patient population. The expected cost for Admission and ED visits was calculated for the RN Outreach support patients. The expected cost = the quantity of patients x the utilization rate x the re-admit/visit rate x the average cost per event. Subtracting the actual cost for the Outreach group from the expected cost resulted in an estimated savings to total cost of care of $2.6M. 72% of patients received ACP support in the Outreach group. The Hospice Utilization rate for the Outreach group was 69% compared to 60% of the not followed group. Patient Experience was positive with patients grateful for the outreach. Conclusions: The EOM Lung Patient Pilot demonstrates that structured nurse outreach for high-risk metastatic lung cancer patients can meaningfully improve key quality and utilization outcomes. These findings suggest that targeted nurse navigation is an effective strategy to decrease unnecessary hospital admissions and ED visits. Improvements in ACP and hospice utilization were also seen. This may serve as a scalable approach to improving outcomes in other high-risk oncology populations. Outreach Not Followed Qty of Pts 199 2,008 % w/ Admits 31% 65% Avg LOS 5.92 6.08 ReAdmit Rate 1.63 2.12 % w/ ED Visits 27% 52% ReVisit Rate 1.74 2.06 ReAdmit & ReVisit Rate = Total Events / Qty of Pts with Events.