2597 - Improving Compliance with On Treatment Management Visits Using a Software Clinical Decision Support Tool
Presenter(s)
P. R. Patel1, W. G. Chin1, H. A. Al-Hallaq2, and E. Schreibmann2; 1Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 2Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA
Purpose/Objective(s): The management of patients receiving radiation therapy requires ongoing synthesis of on-board imaging findings, toxicity assessments, tumor response and social/emotional factors. The ASTRO APEX accreditation standards include direct patient examination once every five fractions for this reason. We sought to assess compliance with on-treatment visits once within each five fraction block and test the impact of a clinical decision support tool in a large, multi-site academic health system.
Materials/Methods: We developed a software clinical decision support tool, OTVwatch, to query the EMR and assess compliance with a completed physician on-treatment visit (OTV) once within each five-fraction treatment block. The physicians and nursing staff were trained on the use of this tool and nurses were empowered to schedule ad hoc OTVs as needed to maintain compliance. Reminders were sent automatically to the clinical care team when OTVs were missed and required rescheduling. The primary outcome of this study was OTV compliance which was defined as the presence of a signed physician OTV note at least once per five fraction treatment block. Two 6-month time periods were retrospectively reviewed: T1 was before the roll out of OTVwatch and T2 was a calendar-matched period after OTVwatch was in routine use. The Pearson chi-squared test was used to compare distributions. The association between year and OTV compliance was assessed using multivariable logistic regression adjusting for hospital location and number of fractions.
Results: The analysis included all external beam radiation treatment courses at 5 hospitals; T1 and T2 included March-September of 2022 and 2024, respectively. Within T1 and T2, the total number of treated patients (2273 and 2766) and mean age (60.7 vs. 61.3) were not different (p>0.05) whereas mean fractions/course decreased from 16.0 in 2022 to 15.0 in 2024 (p<0.05).The four most common diagnoses included breast cancer (10%), prostate cancer (7%), bone metastasis (3%), and brain metastasis (1%). Overall OTV compliance increased from 77.1% in T1 to 88.3% in T2 (p<0.01). In multivariable logistic regression adjusting for hospital location and number of fractions, OTV compliance was higher in T2 compared with T1 (adjusted odds ratio 2.35, 95% CI 2.13–2.59; p<0.01).
Conclusion: Use of a software clinical decision support tool improved compliance with OTV scheduling. EMR vendors should consider inclusion of this type of decision support to improve quality of care for patients receiving radiotherapy.