3644 - A Novel Simulation Framework for Evaluating and Optimizing Oncology Outreach Policies
Presenter(s)
B. T. Scodari1, A. J. O'Malley2, N. S. Kapadia3, G. Brooks4, A. Korsberg1, and E. L. Moen5; 1Dartmouth College, Hanover, NH, 2Geisel School of Medicine at Dartmouth, Lebanon, NH, 3Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, 4The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, 5Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH
Purpose/Objective(s): Oncology outreach is a common strategy for addressing rural cancer workforce shortages, where traveling oncologists commute across healthcare settings to extend specialized care. However, methods for evaluating and optimizing oncology outreach strategies are limited.
Materials/Methods: Using 2020-22 Dartmouth Health data for patients with breast, colorectal, and lung cancer, we identified satellite clinics within the hub-and-spoke system as candidates for increased outreach based on historic incidence rates and oncologist volume. We used simulations to quantify round-trip patient travel time savings and corresponding measures of uncertainty if a proportion of hub-hospital oncologist volume was shifted to the satellite candidate the following year. Optimal volume shifts were determined by maximizing patient travel time savings.
Results: We identified Dartmouth Health’s satellite cancer clinics at St. Johnsbury, VT and Manchester, NH as potential candidates for increased medical and radiation oncology outreach, respectively. For St. Johnsbury, we found that reallocating 45% of hub medical oncologist volume resulted in 148 (95% CI: 107–189) total hours saved for patients. For Manchester, we found that relocating 50% of hub radiation oncologist volume resulted in 54 (95% CI: 34–74) total hours saved for patients.
Conclusion: Simulations offer a valuable means to assess the effectiveness and uncertainty of prospective oncology outreach strategies for increasing patient access to care. Such approaches are well positioned to provide upstream decision support for health systems and can be leveraged to inform optimal workforce allocations.