CONFIDENTIAL AND PROPRIETARY

Personalized Care Plans: Harnessing Technology and Patient-Reported Outcomes to Drive Quality Care

Across the Cancer Continuum

Carrie Tompkins Stricker, PhD, RN

Chief Clinical Officer, On Q Health, Inc.

• To provide a brief overview of challenges to providing coordinated, patient-centered care across the cancer continuum

• To describe an innovative technology and content solution designed to address these challenges, the On Q Care Planning System (CPS)TM

• To describe preliminary feasibility, usability, and satisfaction data related to use of the On Q CPS in breast and GYN cancer populations

CONFIDENTIAL AND PROPRIETARY 2

Objectives

3

IOM: Domains of the

Cancer Care Continuum

• Cancer care is fragmented and quality is inconsistent

• 35-45% of patients have significant distress, which leads

to poorer clinical outcomes and increased costs

• Physical symptoms are prevalent and often under-

identified and inadequately managed, leading to adverse

outcomes

• 56% of cancer patients visit the ED each year, 63% result

in hospitalizations (20% re-admissions within 30 days)

– Symptoms are a top reason for these health care utilization

events

CONFIDENTIAL AND PROPRIETARY 4Advisory Board Company, 2013

Challenges in Cancer Care

Advisory Board Company, 2013

Rocque G B et al. JOP 2013;9:51-54

• Palliative care is not systematically integrated

– Palliative care is only recommended for 21% of cancer patients.

– ~600,000 cancer patients in the U.S. die each year, 60% of which are admitted to the hospital in last month of life

• Post-treatment cancer survivorship care presents unique challenges

– Care is fragmented and poorly coordinated

– Care providers have gaps in knowledge about post-treatment concerns

CONFIDENTIAL AND PROPRIETARY 5

Palliative and survivorship care

Cancer survivorship: What are the issues?

• Cancer survivors are:

– seen less often by the cancer care team

– at risk for many possible late effects of treatment

– have many unmet needs

• psychological, social concerns

• persistent symptoms

• functional recovery

- Hewitt, Greenfield, & Stovall (2005). From Cancer Patient to Cancer Survivor: Lost

inTransition. The National Academies Press: Washington, D.C.;

Click to edit Master title style

• Click to edit Master text styles

– Second level

• Third level– Fourth level

» Fifth level

Our Mission and Vision

On Q Health is the first technology platform that aggregates and disseminates clinical intelligence, to be used by cancer care stakeholders—clinicians, researchers, patients, third-party payers, the life sciences, and professional societies — to improve cancer supportive care delivery, patient outcomes, quality of life and reduce costs.

Our technology is a hybrid of clinical decision support, patient care planning, and clinical data analytics (CAPHs).

CONFIDENTIAL AND PROPRIETARY 7CAPHs = Clinical Analytics for Population Health

• What was the impetus for to develop the On Q Care Planning System (CPS)?

CONFIDENTIAL AND PROPRIETARY 8

Cancer symptoms are prevalent & inadequately managed

• N = 158 diverse survivors (M = 4.1 years from Dx)

• >95% experience > 1 symptom– Average = 10 symptoms

• Symptoms were identified but undermanaged– 50% had little to no

improvement in outcomes after discussion

– Only 8% were referred to supportive care services

Palmer, Jacobs, Mao, & Stricker (2012).

Care plans: Time-consuming & inefficient

• LIVESTRONGTM Center of Excellence

Network of academic & community cancer

centers (n = 13)

– Reach

• 61.5% of sites serve <10% of breast cancer

survivors

– Average time to prepare/deliver SCP

• 2 ½ - 3 hours per patient

Stricker C, Jacobs L, Risendal B, et al: Journal of Cancer Survivorship 5:358-370, 2011.

• Typically symptom related and occurs between clinic visits

• ED management leads to unnecessary hospitalizations, inappropriate utilization of services, and lower quality

• Mayer (2011) – More than 50% of patients

– >60% admitted

– identified the top symptoms leading to ER visit

CONFIDENTIAL AND PROPRIETARY 11Advisory Board Company, 2013

ED = Emergency Department

SYMPTOMS LEAD TO ER AND

URGENT CARE VISITS

0%

5%

10%

15%

20%

25%

30%

Enters limited clinical data*

On Q Rules Engine App generates

CDS for oncologists via a customized

draft patient care plan

that incorporates relevant oncology

quality standards

PROPRIETARY & CONFIDENTIAL 12CDS = Clinical Decision Support

*Temporary solution until HL-7 interfaces are available

Patient completes a

disease and

treatment-specific

questionnaire on a

mobile device at

each visit.

Care Team

Patient

Oncologist finalizes

and nurse counsels

patient on care plan

recommendations

What is On Q CPS™?

Patient e-reports outcomes of

previously recommended

interventions.

CONFIDENTIAL AND PROPRIETARY 13

Existing Care Gap On Q Care Planning System (CPS) Solution

Supportive Care Assessment Clinician screens, non-systematic Patient self screens using validated assessment tools

Patient-Reported Outcomes Not structured, cannot evaluate QoL data in comparative effectiveness studies

Structured, influences treatment pathways that are most efficacious, least symptom burden, and cost effective

Symptom Management Not consistently evidence-based Recommendations rooted in evidence/current research

Quality Measure Adherence Not tracked Tracked individually and in aggregate to submit for quality certifications

Patient Care Plan/After-Visit Summaries

Not offered typically. When offered, not actionable for patients

Gives an actionable plan to engage patients and families in care and selfmanagement of symptoms

On Q CPS Helps to Address Cancer

Care Challenges

Quality In = Quality Out

CONFIDENTIAL AND PROPRIETARY 14

On Q CPS™ Supports Clinician

Adherence to Most Quality Initiatives

By 2015, On Q Care Plans will offer care plan content for 70% of cancer types

Data source: Siegel, R., C. DeSantis, et al. (2012). "Cancer treatment and survivorship statistics, 2012." CA: A Cancer Journal for Clinicians 62(4): 220-241.HNC (Head and neck cancer) = Thyroid, oral cavity, esophageal, & pharynx GU = urinary bladder, kidney, & renal pelvis

On Q Coverage of Cancer Types

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

100,000

200,000

300,000

400,000

500,000

600,000

Breast(female)

Lung &bronchus

Colon &rectum

Urinarybladder

HNC NHL Melanoma(skin)

Ovary &uterine

Pancreas Myeloma CLL Other

PROBLEM AREAS

OCCURRENCES CUMULATIVE PERCENT

CONFIDENTIAL AND PROPRIETARY 16

Cancer Experts Across the U.S.

Develop On Q Content

Red = MDs Blue = Nurses

CONFIDENTIAL AND PROPRIETARY 17

Pain (7 unique algorithms) Cognitive dysfunction Vaginal Stenosis Platinum Toxicity

Breakthrough Nausea Depression Thromboembolism Pneumonitis

Constipation Sexual Dysfunction Weight gain Premature Menopause

Cough Cognitive Impairment Muscle cramps Prevention of CIPN

Diarrhea Fear of Recurrence Fluid retention Radiation Entiritis

Dyspnea Vaginal Stenosis Musculoskeletal pain Rash

Fatigue Fistula Hepatotoxicity Risk of Secondary Cancers

Anemia Genetic Counseling Headache Sexual Dysfunction

Anorexia Hand-Foot Syndrome Pleural effusions Sleep Disorders

Anxiety Hot Flashes Pancreatitis Surveillance Recurrence

Arthralgias Interstitial Lung Disease Pruritis Urinary Complications

Peripheral Neuropathy Renal Failure DVT prophylaxis Secondary Malignancies

Bone Health Mucositis Infection prophylaxis Thrombocytopenia

Bowel Obstruction Neutropenia Fever UE Lymphedema

Cardiotoxicity Noninfectious Pneumonitis Hemorrhage Vaginal Atrophy

Arterial Ischemic Events Hypertension Abdominal Pain QT Interval Prolongation

For select topics, On Q offers accredited training for our clinician users

On Q CPS™ Covers 65 Supportive

Care Topics …and Expanding

CONFIDENTIAL AND PROPRIETARY 18

On Q Content Partners Will

Multiply As We Add Cancer TypesProfessional Society Guidelines Advocacy Group Patient Education

CONFIDENTIAL AND PROPRIETARY 19

CURRENT PILOTS

BILLINGS CLINIC CANCER CENTER

MOFFITT CANCER CENTER

UNIVERSITY OF MICHIGAN

THOMAS JEFFERSON UNIVERSITY HOSPITAL

GEORGE WASHINGTON UNIVERSITY

HARTFORD HEALTHCARE

CLEVELAND CLINIC TAUSSIG

Current On Q/

Cancer Center Collaborations

Demo

CONFIDENTIAL AND PROPRIETARY 20

Jeannine Brant, PhD, RN1

Carrie Tompkins Stricker, PhD, RN2

William Dudley, PhD3

Paul Jacobsen, PhD4

Supportive Care Plans: Harnessing technology and patient-reported outcomes

to drive quality care across the cancer continuum

Preliminary Analysis

1Billings Clinic Cancer Center, 2On Q Health, Inc , 3Piedmont Research Strategies , 4Moffitt Cancer Center

Method

Prospective, multi-center pilot study at 2 NCI-affiliated centers

(a comprehensive community cancer program [NCCCP] in the Western U.S.,

and a NCI-designated comprehensive cancer center [NCCC] in the SE U.S.).

• 100 patients and their providers will participate;

• 50 women with gynecological cancers on chemotherapy

• 50 women on adjuvant hormonal therapy or post-treatment

surveillance for breast cancer.

Patients complete an ePRO assessment and are given an electronically

generated, personalized supportive care plan by their providers during office

visit(s) over a 3-month period. Study outcomes evaluated at baseline and 6

weeks include:

• Feasibility/usability of the platform (patient/provider

• Post-test only; surveys/platform statistics)

•Adherence to care plan recommendations (post-test survey only) and

adherence to QOPI and ONS quality metrics; (analysis on-going).

Enrollment and Participation*

PATIENTS

• 43 patients at the NCCC have enrolled

• 16 have completed both baseline and 6 week measures

• 19 patients have enrolled at the NCCCP

• 7 have completed both baseline and 6 week measures

•Comparative data available on N=23

PROVIDERS

• 10 providers at the NCCCP and the NCCC are either

scheduled for or have completed post-test assessments.

*As of 9/30/14; Updated enrollment numbers available.

Results

Preliminary analysis supports high patient and

provider satisfaction including improvements in

patient-provider communication.

Results

Preliminary interview data: PatientsSelect patient quotes (n = 10 patient interviews to date)

Improves communication with provider

• “The care plan reminds you to bring up issues,

guides the discussion, and gives doctor a

better overall picture of what’s going on with

you.”

• “I was able to …touch base on all key points

that might have otherwise get lost - Visit much

more thorough because of care plan”

Provides helpful, accessible information

• “With the On Q care plans, I have all the

information I need right here…if I need more,

then the other weblinks in the care plans were

very helpful.”

Helpful for managing symptoms

• So helpful to me that I used it to help

another patient (a relative) who is going

through treatment and lacked a lot of info the

care plan addressed (i.e. managing nausea)

• “Care plan recommended a change to my diet

… within a few weeks was completely off a

medication. Big change in my life based on

recommendations of the care plan with a

profoundly positive outcome.”

• “Very helpful to me in managing my

symptoms.. exercise sheet very helpful, tips

on dealing with nausea. Wish I had had earlier

in treatment before joining the study”

Results

Preliminary interview data: ProvidersSelect provider quotes (n = 4 MDs/NPs to date)

Improves visit efficiency

• “I can’t say enough about the On Q Care

planning system” … I think its extremely

helpful in making the visit much more complete

and efficient …

• With all the issues cancer patients can have,

there’s only so much time one has in a day, so

the care plan improves efficiency by helping

me 'cut to the chase’ and highlight the top

issues from both the patient and clinical

perspective, focus the visit on these, and then

provide them with targeted resources and

referrals for their indivdual concerns and

needs.

Helps facilitate visit

• “Helps identify problems and issues patients don’t tell me otherwise. Allows me to direct encounter to patient needs and goals of care in a way I am not typically able.” (Cancer Center director)

• “On Q care plans help to focus my visits – this was especially helpful one day when I was running 2 ½ hours behind” (Breast oncologist)

Overall system use

• “I want to have this in my practice on an ongoing basis!”

• “The system is fantastic. It is what you and I would want if we had cancer. I tell all my patients to use it.” (GYN oncologist)

Results

Provider satisfaction with care plan: (n=5) Using a 1-5 scale with 1=Strongly disagree and 5=Strongly agree

Overall satisfaction

Customized to the individual patient

Usefulness of the “Clinical Considerations” information

Easy to understand

Appropriatness or recommendations and tasks

Improves patient-clinician encounters and communication.

Helps identify and assess symptoms and concerns

Helps apply evidence-based practices for symptom management andsupportive care.

Would recommend as a clinical decision support system for symptommanagement and supportive care.

Helps address my patients’ concerns and distress.

Saves time.

Would recommend other providers use

4.4

4.6

4.25

4.6

4.6

4.2

4.2

4.6

4.4

4.8

3.8

4.4

Conclusions

The On Q CPS is a novel supportive care planning

technology developed to improve care processes

and patient outcomes through the delivery of

personalized electronic care plans.

Feasibility, usability, acceptability, satisfaction and

exploratory outcome data will be presented.