Patient Experience Programs Improve Overall Quality of Care

Transitions in care can be a complicated process for a patient with cancer. Comprehensive programs are needed to help engage patients and their families’ on multiple levels and always ensure safe care.

The University of Texas MD Anderson Cancer Center, a National Cancer Institute-designated comprehensive cancer center, takes great pride in its ability to respond to patients who are most in need. Therefore, MD Anderson created
a comprehensive call center available 24/7 to improve the patient experience. The comprehensive program seeks to utilize the right level of staff at the right time with the right service. This has been created through “askMDAnderson,” a comprehensive call program designed by patients for patients, which is staffed with operators, health information specialists, nurses, and associated providers to address each level of care.

AskMDAnderson also increases patient satis- faction by providing discharge phone calls for all patients discharged from inpatient, outpatient surgery, and the emergency department.¹

Different Levels of Service

The operators represent the first level of service. This team handles over $1 million worth of calls per year. Operators provide patients and families with directions, visitor guidelines, parking details, meal distributions, COVID-19 testing, password reset assistance, code blues, and merit call at all locations. They keep patients and families informed of the most updated information to ensure confidence throughout their cancer journey.

The second level of service is the health information team and referring provider team. These teams are designed to ease the referral process. Patients and referring physicians can call when- ever they want, and the staff gladly walks them through the referral process, discusses research protocols, and estimates when the person will be seen by a physician. These teams provide a critical information link to prospective patients and their family members for all transitions in care needs, as well as education about MD Anderson’s services, programs, treatments, and clinical trials

to prospective patients, families, and health care providers. They also assist patients in assessing the electronic medical record and video visit or any electronic medical record inquiry.

Houston is a very competitive market, and although patients want the best cancer center nationally, they want quick service as well. This team assists 2500 referrals each month and is available 24/7.

Patient Care During the COVID-19 Pandemic

The COVID-19 pandemic resulted in strict visitor restrictions, mandated testing and/or quarantine for patients, trepidation of coming to the emergency center or hospital, and panic among those with fever, coughs, or sore throats. These are all symptoms of COVID-19, but they are also sequela of medical treatments for chronic illnesses, such as cancer. Consequently, AskMDAnderson became a vital source of information and education for patients and their families in real time. Timely answers to questions and education about safety procedures and symptom triage has allayed fears and helped make patient visits efficient and effective.

Two new clinical programs were launched in 2019. These included discharge phone calls after all inpatient, outpatient, and emergency department visits and an After Hours Clinical Support program, which is designed to help the patient and physicians on call after the centers have closed. In the current COVID-19 era, the askMDAnderson clinical team became available 24/7.

Due to the complexity of clinical presentation and limited provider-based resources, patients with cancer and their families often telephone their physician or cancer clinic to seek advice.² Furthermore, when patient care shifts from an inpatient to outpatient setting, there is need for oncology nurses to not only know about disease processes and clinical patient care but also be skilled in telephone nursing triage.³ The After Hours Clinical Support enables patients to speak with a nurse when clinics are closed, rather than paging a provider and waiting for a call back. These clinically trained nurses manage patient issues and concerns that are within their scope, but they will also refer issues to the provider when necessary.

Research has shown activities like these elevate the quality of care patients receive.^4,5 Such activities also lower the overall costs of care of an organization and protects the time and capacity of emergency centers and hospitals to care for their most critical patients.^6,7 This results in a safer, more efficient, less expensive, and better experience for patients.

In the initial 6 months of the new program, specific clinical services provided feedback about the algorithms utilized to determine when to page the physician on call. Despite the need to change some of the algorithms, incremental improvements were already seen in readmission rates, which decreased by 1%. In addition to
care coordination, working to protect the health of a uniquely vulnerable cancer population, the cancer network was able to share best practices for entrance screening, critical patient surge preparations, telehealth visit transitions, and personal protective equipment use.

Cancer care cannot stop during a pandemic. Furthermore, the amount of information patients need to successfully navigate their cancer journey can be daunting. Programs like the askMDAnderson call center help alleviate some patient stress and provide critical information. Broad implementations of similar programs may help facilitate easier navigation across health access barriers moving forward.

References

1. Finder JP, Proske A, Overton J, Garcia EC, Frumovitz M. A comprehensive call center supporting safe, efficient operations during a pandemic. PXJ. 2020;7(2). doi:10.35680/2372-0247.1456
2. Rosenbaum, L. The untold toll – the pandemic’s effect on patients without COVID-19.
   N Engl J Med. 2020;382(24):2368-2371. doi:10.1056/NEJMms2009984
3. Bunik M, Glazner JE, Chandramouli V, Emsermann CB, Hegarty T, Kempe A. Pediatric telephone call centers: how do they affect health care use and costs? Pediatrics. 2007;119(2):e305-e313. Doi:10.1542/peds.2006-1511
4. Long-term care hospital prospective payment system proposed rule for rate year 2007. News release. CMS; January 19, 2006. Accessed June 30, 2020. https://www.cms.gov/newsroom/fact-sheets/long-term-care-hospital-prospective-payment-system-proposed-rule-rate-year-2007
5. McFarland DC, Walsh L, Napolitano S, Morita J, Jaiswal R. Suicide in patients with cancer: identifying the risk factors. Oncology (Williston Park). 2019;33(6):221-226.
6. Coons K, DuMoulin JP. Telephone triage. American College of Physicians—American Society of Internal Medicine. Accessed June 3, 2020. https://www.acponline.org/acp_policy/policies/telephone_triage_diagnostic_techniques_procedures_2000.pdf
7. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111(9B):26S-30S. doi:10.1016/s0002-9343(01)00966-4