MVP CAN model: Accelerating cancer diagnosis for underserved inpatients to bridge health gaps.

Abstract

e13546 Background: Temple University Hospital-Main Campus (TUH) of TU health system (TUHS) is in North Philadelphia, Pennsylvania (USA) where 40% of residents live below the poverty line. Patients (pts) encounter multiple social determinants of health (SDOH) and face cancer health disparities. Institutional data from Fox Chase Cancer Center (FCCC of TUHS), show that pts with cancer at TUH present with more advanced stage and have worse outcomes. Incidental suspected cancer findings occur during inpatient hospitalizations for unrelated conditions. An approach is needed to avoid delayed workup and missed diagnoses, as oncologic care requires complex diagnostic testing and specialty input. The Multi Visit Patient Cancer Clinic (MVP CAN), led by TUH and in collaboration with FCCC, was created to bridge the gaps and streamline diagnostic workup for suspected cancer findings from the inpatient setting. Methods: MVP CAN model expedites outpatient diagnostic workups for suspicious cancer findings upon inpatient providers placing an electronic order. MVP CAN model includes i) an in-person transitional clinic led by a physician internist for those pts without a PCP or facing health literacy challenges, and/or ii) virtual coordination and an e-consult with the appropriate subspecialist to assess urgency and determine next steps, inclusive of procedural outpatient interventions. MVP CAN includes a navigator who coordinates tests, follow-ups, specialty appointments, and addresses SDOH with a trauma-informed approach. Here, we present results of the pilot implementation. Results: MVP CAN launched in May 2024 with data cutoff Dec 2024. 156 inpatients were referred, with 33% seen in-person and 67% managed virtually. Additionally, 56% had a subspecialty e-consult. Characteristics included: median age 62 yrs; 63% Black, 20% Hispanic, 11% White, 2% Asian; 59% Male, 41% Female; and 12 patients initially uninsured. Of 134 who completed workup: 51% were diagnosed with cancer including 42% referred to Oncology for treatment and 9% to Hospice, while 30% required ongoing surveillance. 13% were lost to follow up and 3% died. The most common cancers ( > 5) were NSCLC, colon, pancreatic, and prostate, with 18% stage III & 69% stage IV. Median time from program entrance to first oncology visit was 22 days (range 3-110). Conclusions: MVP CAN addresses a critical gap in transitioning care from inpatient to outpatient for underserved pts with suspected cancer while concurrently addressing SDOH. Over half of pts referred and completing workup were diagnosed with cancer, with most presenting at advanced stages. This highlights the need for navigation structured programs to enhance timely diagnosis and treatment and address access barriers and SDOH. Ongoing analysis will evaluate time to treatment and survival to assess the impact of MVP CAN on advancing health equity.