Lindsay Conway, Oncology Roundtable
Administrators at Consultants in Medical Oncology and Hematology, PC (CMOH)—a nine-oncologist private practice in Drexel Hill, Pa.—recently explained to us how they used a telephone triage system to decrease ED visits and hospital admissions while empowering patients to more actively manage their care.
Phone triage system central to CMOH medical home model
In April 2010, CMOH became the first oncology practice in the nation to earn Level III recognition from the National Committee for Quality Assurance (NCQA) under its Physician Practice Connections—Patient Centered Medical Home program. As a medical home, CMOH assumes primary responsibility for coordinating all related services for patients requiring complex evaluation and active treatment for cancer conditions.
Five features distinguish CMOH from other practices:
- Active patient engagement
- Extensive patient navigation infrastructure
- Comprehensive EMR with disease registry capabilities
- Consistent timely communication with all involved physicians
- Telephone triage system
Practice administrators say that, of these, the telephone triage strategy has emerged as an essential factor in CMOH’s success as a medical home. They link the approach to a 65% decrease in ED referrals across a five year period and a 43% decrease in overall hospital admissions per chemotherapy patient per year. Notably they achieved these gains despite a simultaneous 30% increase in patient volumes.
CMOH nurses: The backbone of the system
The phone triage line—which receives 15-20 symptom-related calls per weekday—operates from 7 a.m. to 6 p.m. Monday through Friday. On any given day, one RN is dedicated to managing the phone triage line. Two additional RNs are available to provide back up. They work in the infusion center, but have flexible responsibilities so that they can be interrupted to take calls as needed.
CMOH has four offices with infusion centers, but all of the phone triage is centralized at their largest site. The chemotherapy nurses there rotate responsibility for phone triage every 3-4 days and spend the remainder of their time working in the infusion center.
After 6 p.m., calls are redirected to an answering service, with the physician on call fielding patients’ questions. On-call physicians have remote access to the practice’s EMR, allowing them to follow the same symptom management algorithms used by the RNs.
Algorithms created to ensure consistent, timely symptom management
Physicians and nurses manning the phone line follow a set of symptom management algorithms that were originally created in the late 1990s based on Oncology Nursing Society (ONS) guidelines. CMOH has since expanded and greatly modified the algorithms to include additional symptoms and reflect specific management options and recommendations revealed through nurses’ reviews of real-time data from individual patients’ electronic files.
CMOH relies on the algorithms to better serve patients by giving them consistent, standardized, and timely symptom management information that, in turn, prevents time-consuming ED evaluations and unnecessary hospital admissions. All CMOH clinical staff are trained to follow these algorithms in both the clinic setting and for phone triage.
Callers guided to appropriate care setting
Patients typically call the triage line when experiencing cancer-related symptoms or treatment-related side effects, including nausea, vomiting, pain, shortness of breath, fatigue, and skin rashes. Nurses triage patients based on the type of symptoms and their degree of severity. They use the practice’s EMR to track reasons for patients’ phone calls as well as the prescribed interventions.
Most patients calling with a symptom receive instructions for self-management, while a small percentage are scheduled for a same-day appointment in the clinic or are referred to the ED.
‘Accept nothing’ philosophy
The success of the phone triage system depends, at least in part, on patients calling in to report their symptoms before they become crises. To that end, CMOH staff emphasize to patients that they should call with any question or concern. “We tell patients to accept nothing,” says CMOH’s lead physician Dr. John Sprandio. “If you have issues, you call.” This message is routinely reinforced by all members of the CMOH staff who strive at all times to have all symptom related patient calls answered immediately.
CMOH’s leadership has developed a consulting service—Oncology Management Services (OMS)—designed to help other medical oncology providers learn from and emulate CMOH’s achievements with the medical home model. Among its services, OMS currently offers educational and training programs, assessments and gap analysis based on NCQA and Joint Commission medical home criteria, workflow and process-of-care analysis, and IT adoption/creation consultation.
Practices that engage the service undergo an assessment to identify opportunities for improvement, receive guidance from CMOH’s operations experts, and may also implement CMOH’s proprietary software. For more information, please contact Oncology Management Services, Ltd. at 610-887-0390 or email John Sprandio, MD.
Related Resources from the Oncology Roundtable
Members of the Oncology Roundtable can access the study Redesigning Cancer Care for the Era of Accountability to learn more tactics for engaging patients and families as care partners.
Not a member of the Oncology Roundtable? Visit our website or contact us.
- Sprandio JD, “Oncology Patient-Centered Medical Home and Accountable Cancer Care,” Community Oncology, 2010, 7:565-572; Sprandio JD, “Oncology Patient Centered Medical Home: Transforming the Landscape of Oncology Care,” presented at the Cancer Business Summit, Oct. 13, 2011; Oncology Roundtable interviews and analysis.