To provide Standards on the basis of evidence and expert consensus for a pilot of the Oncology Medical Home (OMH) certification program. The OMH model is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement. The OMH pilot is intended to inform further refinement of Standards for OMH model implementation.

An Expert Panel was formed, and a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans was performed using PubMed and Google Scholar. Using this evidence base and an informal consensus process, the Expert Panel developed a set of OMH Standards. Public comments were solicited and considered in preparation of the final manuscript.

Three comparative peer-reviewed studies of OMH met the inclusion criteria. In addition, the results from 16 studies of clinical pathways and one systematic review of survivorship care plans informed the evidence review. Limitations of the evidence base included the small number of studies of OMH and lack of longer-term outcomes data. More data were available to inform the specific Standards for pathways and survivorship care; however, outcomes were mixed for the latter intervention. The Expert Panel concluded that in the future, practices should be encouraged to publish the results of OMH interventions in peer-reviewed journals to improve the evidence base.

Standards are provided for OMH in the areas of patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety. Additional information, including a Standards implementation manual, is available at www.asco.org/standards.

According to the Agency for Healthcare Research and Quality, the direct cost of cancer care in the United States in 2017 was $105.5 billion.1 As the cost of drugs and overall cost of cancer continue to increase,2 there has been increased interest in optimizing the value of care.3 The application of value-based payment models has been challenging because of heterogeneity in how practices deliver cancer care. Proposed alternative payment models, such as bundled payment plans and Accountable Care Organizations, adjust the mechanisms of payment but do not define consistent systems of care delivery. Indeed, these models rely on the change in payment to force changes in care delivery. These changes are not defined and may not be focused on improvements in quality of care.3

Oncology Medical Home (OMH) is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement.4 OMH can serve as a roadmap to guide how a practice delivers high-quality oncology care (a process of practice transformation) and support (but not define) new models of value-based reimbursement.

A systematic review of the evidence was conducted, and the results were combined with expert consensus to create current OMH Standards that outline the key components of the OMH (Bottom Line box). These Standards are needed because they provide a framework for practice transformation to a model that exemplifies efficient and high-quality care in the context of payment reform.5 In addition to a review of studies of the OMH model as a whole, the Expert Panel members (Appendix Table A1, online only) identified the need for reviews of evidence on two subcomponents of the OMH model: clinical pathways and survivorship care plans (SCPs), because of their potential to be resource-intensive and high-cost. The rationale for including these subtopics is outlined in further detail in the Background section. The primary goal of this project is to create Standards that are evidence-based and, where evidence is lacking, to produce Standards statements that are based on the consensus of a multidisciplinary group of experts and incorporate input from appropriate stakeholders. These Standards are designed to support a 2-year ASCO-led Patient-Centered Care Certification Pilot that is currently underway. Following this pilot, the Standard requirements will be assessed and modified as needed. A separate OMH Standards Manual to support implementation has been developed, which includes (1) standard definitions, (2) standard requirements, (3) standard specifications, and (4) tools and resources. Although the OMH Standards Manual is currently in draft format pending the results of the ASCO Certification Pilot, we have added a link to it in the Bottom Line Box so that the proposed details of implementation are easily accessible. Finally, a secondary goal of the evidence review is to identify gaps in the literature and areas where more research is needed.

Patient-Centered Medical Home

The Patient-Centered Medical Home (PCMH) concept of care was introduced by the American Academy of Pediatrics in 1967 with the goal of providing greater centralization and coordination of care to pediatric patients with special needs. After several decades, the PCMH model was adopted by specialists in family medicine in the United States. In 2007, four primary care physician associations in the United States formed the Patient-Centered Primary Care Collaborative and endorsed joint principles for PCMH.6-8 Over time, the PCMH has come to be viewed as a system for health care transformation8 and as a way to achieve the triple aim of controlling health care costs, while improving quality of care and the patient experience.9 According to the Patient-Centered Primary Care Collaborative, core components of the PCMH include physician-led, team-based, coordinated, and patient-centered care, enhanced access, and quality improvement (Box 1).

BOX 1. Principles of Patient-Centered Medical Home10

  • Each patient has a relationship with a personal physician who is responsible for patient health care needs across all stages of care;

  • The practice is physician-led and includes a team of individuals who provide care within the practice;

  • Care is coordinated and/or integrated;

  • Quality and safety aspects include advocacy for patients, continuous quality improvement, patient engagement, evidence-based medicine, and clinical decision support tools, appropriate information technology, and achieving voluntary medical home recognition;

  • Access to care is enhanced;

  • The Patient-Centered Medical Home requires a payment structure that recognizes the added value of the Patient-Centered Medical Home model of care.

Previous systematic reviews have reported mixed outcomes,12 but according to the National Committee for Quality Assurance (NCQA), studies that failed to show a benefit of PCMH tended to be older or were based on outdated or nonuniform Standards.13 An Agency for Healthcare Research and Quality review by Jackson et al looked at studies up to June 2012 of the effects of PCMH on patients, staff, and economic indicators; 19 studies met the inclusion criteria. Moderately strong evidence suggested that the medical home has a small positive effect on patient experiences and a small to moderate positive effect on preventive care services. The study also found a significant reduction in emergency department (ED) visits, but not hospital admissions. The authors considered their findings to be preliminary because of limitations to the analysis including the relatively small number of studies directly evaluating the medical home and the evolving approaches to the medical home model. The authors also found that approaches to implementation (ie, meeting the requirements) varied widely.7 In another systematic review of PCMH, the authors found that most studies did not use rigorous methodology, lacked comparison groups, and relied on before and after studies. When the analysis was restricted to high-quality studies, the authors found some benefits, but mostly inconclusive results. They suggest following practices for longer time periods as implementation may take several years.9 A review of implementation issues associated with PCMH found that challenges included the magnitude of transformation, issues with change management, integration of the system within electronic health records, inadequate funding for transitional costs and sustainability of the model, insufficient resources within the practice to support implementation, and inadequate measures of performance and inconsistent accreditation and Standards.6 Another review found positive effects in low-income patients, although authors also note limitations to the data such as lack of adjustment for confounding factors.11

Oncology Medical Home

Fisher noted that the success of the PCMH model depended on the availability of a hospitable and high-performing medical neighborhood of practices that align their processes with the critical elements of the PCMH.14 Consistent with this observation, the American College of Physicians developed a definition of a PCMH Neighbor with reference to specialty or subspecialty practices.15 The concept of the OMH evolved from the primary care PCMH model and efforts to identify key aspects of effective neighbors.16-18 As with PCMH, features of the OMH include integrated and coordinated team-based care, use of evidence-based medicine and performance measurement, enhanced access for patients, and a payment structure that recognizes the longer-term benefits of investing in the medical home model.19

Early efforts to implement a medical home model in oncology practices met with success in terms of reduced hospitalizations and a favorable impact on the cost of care.18,20,21 Continuing to build on PCMH principles and early medical home in oncology efforts, an OMH model was piloted on a wider scale from 2013 to 2015 within the Community Oncology Medical Home (COME HOME) project, which was implemented for Medicare patients in seven specialty oncology practices across the United States.19 The COME HOME demonstration project reported favorable results in terms of reduced hospital admissions, ED visits, and cost of care.22 The subsequent Center for Medicare and Medicaid Services Oncology Care Model, launched in 190 practices in 2016 and continuing with 127 practices23 until 2021, draws on PCMH principles and early OMH efforts and is tied to an alternative payment model, with incentives to improve value for patients with cancer undergoing systemic therapy. In addition, ASCO's Patient-Centered Oncology Payment model incorporates concepts consistent with the OMH.2

Initial efforts to codify Standards for OMH adapted existing Standards for primary care to oncology practice. Multiple organizations, including the NCQA, the Commission on Cancer (CoC), ASCO, Community Oncology Alliance (COA), the National Coalition for Cancer Survivorship (NCCS), and others, have worked to align existing quality programs to these efforts. Two sentinel, federally funded evaluations of the OMH model provided a framework of Standards that inform this work: the previously referenced COME HOME project (supported by a Center for Medicare and Medicaid Innovation grant), and a Patient-Centered Outcomes Research Institute–funded, NCQA/NCCS–led project that tested the process of transformation of oncology practices in Southeastern Pennsylvania to an OMH model.24 The Standards included within this article are built upon these efforts and the work of COA, along with clinical pathways and chemotherapy safety Standards published by ASCO.25,26

The peer-reviewed comparative studies evaluating the OMH model included in this review were comprehensive in scope—inclusive of patient engagement, navigation and care coordination, evaluation of appropriate use of oncologic therapeutics, and optimal symptom management and end-of-life care.

Clinical Pathways

Clinical pathways, also called critical pathways (CPs) or care pathways, are a methodology for mutual decision making and organization of care for a specific group of patients during a well-defined period of time.25,27,28 Pathways have also been described as document-based tools that provide a link between the best available evidence and clinical practice. A Cochrane review published in 2010 found that the use of pathways resulted in a reduction in in-hospital complications and improvement in documentation.29

ASCO has previously stated that pathways should balance clinical efficacy, safety, toxicities, cost, and scientific advances, including the growing personalization of therapy on the basis of molecular diagnostics.25 Pathways are often created through the input of a multidisciplinary team and frequently prioritize benefits of treatment (eg, survival outcomes), followed by toxicity and finally cost.30,31 Alternatively, they may be focused on reducing variability in care, rather than explicitly reducing costs.32 Pathways can be developed by third-party vendors, payers, or practices. Evaluations of pathways should include assessment of clinical outcomes, service, team, process, and financial outcomes.28

ASCO's position statement also noted several issues with clinical pathways in oncology, including variability and inadequate quality criteria, transparency, conflicts of interest and input from providers, and unsustainable administrative burden when each practice is required to manage many different pathways.25 Previous stakeholder consultations by ASCO on Standards for high-quality pathways resulted in criteria in the areas of development, implementation and use, and analytics.32,33

Despite progress, challenges to the implementation of clinical pathways in oncology still exist; although compliance to pathways can be up to 70%-80% under optimal circumstances,34 a study published in 2016 found that pathway adherence in oncology ranged from 53% to 70%, depending on disease site,35 and tends to decrease with increasing pathway complexity.34 This evidence review aims to build on previous consensus-based work conducted by ASCO and to assemble a summary of recent evidence to support the Standards in the area of clinical pathways. Pathways were chosen as a specific focus of the evidence review because of awareness of the significant resources that can be required for their implementation in clinical practice. Outcomes of the implementation of pathways are considered, as well as lessons learned regarding challenges and enablers of pathway implementation in real-world situations.

Survivorship Care Plans

SCPs are plans that are provided to survivors who were treated with curative intent and have completed active therapy.36 Typically, they include a summary of treatment received by the patient and plans for follow-up care. SCPs were originally recommended by the Institute of Medicine in 2006 and were intended to address barriers to follow-up that are faced by cancer survivors, including unmet needs for information and support.37 Agencies such as the CoC have recommended that all survivors receive an SCP, and ASCO has previously published in support of these plans and developed a template for their use. Taken at face value, SCPs would seem to be a pragmatic intervention to facilitate follow-up care; however, supporting evidence has historically been limited, and consequently, the use of resources to develop these plans has been questioned. As a result, the CoC has recently removed the requirement for SCPs from its 2020 Standards and instead focuses its new requirements on the formation and evaluation of a survivorship program, while continuing to recommend and encourage the use of SCPs.38 Because SCPs were identified as potentially resource- and cost-intensive, as well as controversial and evolving, an evidence review was conducted on this topic inform the level of obligation associated with the relevant standard.

THE BOTTOM LINE

Oncology Medical Home: ASCO and COA Standards

Research Questions

  1. Does the OMH model result in improved patient-centered outcomes for patients with cancer, compared with usual care or another intervention?

  2. Within the OMH model, do clinical pathways and SCPs result in improved outcomes for patients or survivors?

  3. What are the Standards for an ASCO OMH pilot, on the basis of the evidence review and expert consensus?

Target Patient Population

The target population includes patients receiving treatment for cancer or survivors who have undergone curative treatment for cancer.

Target Audience

Health care plan administrators, payers, oncologists, and other clinicians involved in the delivery of cancer care.

Methods

An Expert Panel was convened to develop Standards on the basis of a systematic review of the medical literature.

Standards

Note: documentation requirements for each statement are provided in the Data Supplement (online only).

Global Statement

Health equity is achieved when everyone has the opportunity to attain their highest level of health39; equity is a priority for practices throughout the continuum of cancer care. Within each domain of these Standards, practices should be guided by the ASCO policy statement on cancer care disparities and endeavor to (1) ensure equitable access to high-quality care, (2) ensure equitable research, (3) address structural barriers, and (4) increase awareness and action.40

A. Patient engagement
Standard A1.

All patients are provided with an initial orientation to the OMH model and ongoing reinforcement of policies related to this model.

Standard A2.

Patients will routinely be provided with a best estimate of out-of-pocket expenses for any new therapy that is offered. Patient financial counseling services, including assistance programs that are available, are routinely provided to all patients in the OMH practice.

Standard A3.

All patients are provided with education on their cancer diagnosis, goals of treatment, and an individualized treatment plan.

Standard A4.

The OMH practice develops and implements a team-based survivorship care program for all eligible patients, including identification of responsible staff, timeline for implementation, and documentation of existing supports and new services in development; treatment summary and survivorship care plan are encouraged as part of the survivorship care program, but are not required. Inclusive in the survivorship care program are appropriate strategies for transition back to primary care in appropriate patients.

B. Availability and access to care
Standard B1.

The OMH practice institutes expanded access and an evidence-based symptom triage system to ensure that patients can easily access the practice and their providers.

Standard B2.

The OMH practice tracks patient ED visits, hospital admissions, and readmissions; analyzes the data regularly for process improvement and patient education purposes; and provides patient follow-up within an appropriate timeline posthospitalization or ED visit.

Standard B3.

Documentation and follow-up for patients who miss or cancel scheduled visits and/or chemotherapy treatments.

C. Evidence-based medicine
Standard C1.

The OMH practice uses value- and evidence-based treatment and supportive care pathways, measures and reports on physician compliance with pathways, and requires documentation for off-pathway treatment.

Standard C2.

Patients are provided clinical research study information by the OMH practice as appropriate for the patient's clinical condition.

D. Equitable and comprehensive team-based care
Standard D1.

In most instances, a medical oncologist directs the patient's care team within the OMH practice, care coordination with the patient's primary care physician, and/or other pertinent physicians and services, including ongoing collaboration with the in-patient team.

Standard D2.

The OMH practice prioritizes team-based care with policies and procedures that clearly delineate roles and responsibilities, implements and prioritizes team huddles or other methods of information sharing as a communication and patient safety tool, and regularly assesses how the practice team is functioning.

Standard D3.

All patients are provided navigation for support services and community resources specific to their individual needs and preferences; psychosocial distress screening is performed, and referral for the provision of psychosocial care is provided, as needed. Support services may be delivered on-site or through an off-site collaboration.

Standard D4.

Health equity is a priority for the practice throughout the continuum of cancer care. The practice should have a policy that addresses the health equity domains outlined in the Global Statement. Developing awareness of conscious and unconscious biases of all practice team members should be a focus of the practice and resources made available to assess and drive change where appropriate.

E. Quality improvement
Standard E1.

The OMH practice administers a patient experience survey to patients with cancer at least twice each calendar year or on an ongoing basis (this includes surveys completed to fulfill other requirements). The results of the survey are analyzed and used to guide quality improvement activities.

Standard E2.

The OMH practice demonstrates a commitment to quality improvement by regularly using data to evaluate a process of care, implementing changes if or when indicated from analysis, and monitoring sustainability of improvement over time. Patient-reported outcomes may be used as part of this improvement process, where resources allow and infrastructure, policies, and procedures are in place to ensure a timely response to patient reports.

F. Goals of care and palliative and end-of-life care discussions
Standard F1.

Practice routinely offers an advance care planning discussion and completes a goals of care discussion with all patients that recognizes the individual patient's needs and preferences. For patients who choose to participate in this discussion, advance care planning would include advance directives and consideration or selection of an agent for medical decision making.

Standard F2.

For patients with advanced cancer and/or metastatic cancer OR patients with limiting comorbid conditions, the practice performs an advance care planning discussion, which includes a review of advance directives in place, consideration or selection of an agent for medical decision making, discussion regarding symptom management, and discussion of patient goals for end-of-life care.

G. Chemotherapy safety
Standard G1.

Practice meets Quality Oncology Practice Initiative (QOPI) Certification Program Standards (see Additional Resources), which include requirements for detailed discussion of treatment options and patient consent. OMH Chemotherapy Safety Standards are equivalent to the QOPI Certification Program Standards for safe chemotherapy administration.

Additional Resources

More information, including a Supplement with additional evidence tables, is available at www.asco.org/standards. Patient information is available at www.cancer.net. ASCO QOPI information and resources are available at QOPI Certification Program and QOPI Certification Program Standards. The OMH Standards Manual at asco.org/standards provides details about the implementation of these Standards in oncology practices. The ASCO Standards Methodology Manual provides additional information about the methods used to develop these Standards.

  1. Does the OMH model result in improved patient-centered outcomes for patients with cancer, compared with usual care or another intervention?

  2. Do detailed, evidence-based treatment protocols (pathways) improve the appropriate use of therapies or interventions for patients who are receiving treatment for cancer?

  3. Do SCPs result in improved outcomes for patients who have received curative treatment for cancer?

  4. What are the Standards for an ASCO OMH pilot, on the basis of the evidence review and expert consensus?

Standards Development Process

This systematic review-based standard was developed by a multidisciplinary Expert Panel, which included stakeholder representation from clinicians, health system administrators, as well as a patient representative, and an ASCO staff member with health research methodology expertise. The Expert Panel met via teleconference and/or webinar and corresponded through e-mail. On the basis of the consideration of the evidence, the authors were asked to contribute to the development of the Standards, provide critical review, and finalize the standard statements. The statements were sent for an open comment period of 2 weeks, allowing the public to review and comment after submitting a confidentiality agreement. These comments were taken into consideration while finalizing the Standards. Members of the Expert Panel were responsible for reviewing and approving the penultimate version of the draft, which was then circulated for external review and submitted to the JCO Oncology Practice (JCO OP) for editorial review and consideration for publication. All ASCO Standards are ultimately reviewed by the Expert Panel and the ASCO Quality of Care Council and approved by the ASCO Board of Directors before publication. For this joint project, the draft manuscript was also reviewed by COA's Payment Reform Committee. All funding for the administration of the project was provided by ASCO.

PubMed, Cochrane Database of Systematic Reviews, and Google Scholar were searched for systematic reviews, prospective or retrospective observational studies, or randomized controlled trials published between January 2010 and April 24, 2020. The search for studies of clinical pathways and SCPs were extended to July 15, 2020, and September 3, 2020, respectively. Articles were selected for inclusion in the systematic review of the evidence for OMH on the basis of the following criteria:

  • Population: Patients receiving cancer care treatment or survivorship care in community oncology practices

  • Intervention: OMH care delivery model in specialty care

  • Comparison: Another oncology care model (either evaluated concurrently or using a historical control group).

  • Outcomes: Emergency room or ED visits, hospitalizations, chemotherapy safety (risk of errors), patient-reported outcomes such as satisfaction, and cost. Outcomes that were adjusted for factors such as age of patients and stage of disease were extracted where reported.

Articles were selected for inclusion in the systematic review of the evidence for pathways in oncology on the basis of the following criteria:

  • Population: Patients receiving cancer care treatment in community oncology practices

  • Intervention: Oncology clinical pathways, also known as CPs, or care pathways

  • Comparison: Usual care, before pathway implementation or other model of intervention

  • Outcomes: Process: Length of stay (LOS), inpatient admissions or readmissions, variability of administered drug combinations, and appropriate use of therapies; clinical: disease-free survival, overall survival (OS), morbidity rates, and complication rates; and patient-reported: quality of life (QOL), anxiety, and patient satisfaction. Outcomes that were adjusted for factors such as age of patients and stage of disease were extracted where reported.

Articles were selected for inclusion in the systematic review of the evidence for SCPs in oncology on the basis of the following criteria:

  • Population: Patients receiving survivorship care following curative treatment

  • Intervention: SCP with treatment summary

  • Comparison: Usual care and other models of survivorship care

  • Outcomes: Patient knowledge and satisfaction, depression, anxiety, time to recurrence, survival, and QOL.

Articles were excluded from the systematic review if they were (1) meeting abstracts; (2) editorials, commentaries, letters, news articles, case reports, and narrative reviews; and (3) published in a non-English language, because of limited capacity for translation. The complete search strategy is available in the Data Supplement. Relative risks (RRs) were calculated using RevMan 5.3.

The Expert Panel and staff will work with cochairs to keep abreast of any substantive updates to the standard. On the basis of formal review of the emerging literature, ASCO will determine the need to update. The ASCO Standards Methodology Manual provides additional information about the update process. This is the most recent information as of the publication date.

Conflicts of Interest

The Expert Panel was assembled in accordance with ASCO's Conflict of Interest Policy Implementation for Clinical Practice Guidelines (“Policy,” found at http://www.asco.org/rwc). All members of the Expert Panel completed ASCO's disclosure form, which requires disclosure of financial and other interests, including relationships with commercial entities that are reasonably likely to experience direct regulatory or commercial impact as a result of promulgation of the standards. Categories for disclosure include employment; leadership; stock or other ownership; honoraria, consulting or advisory role; speaker's bureau; research funding; patents, royalties, other intellectual property; expert testimony; travel, accommodations, expenses; and other relationships. In accordance with the Policy, the majority of the members of the Expert Panel did not disclose any relationships constituting a conflict under the Policy.

Standards Disclaimer

The Standards published herein, and any documentation linked to from the Standards, including, but not limited to the OMH Standards Manual, are provided by the American Society of Clinical Oncology, Inc. (ASCO), and/or the Community Oncology Alliance (COA), to assist providers in clinical decision making. The information herein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. ASCO provides this information on an “as is” basis and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions.

Oncology Medical Home

Three systematic reviews of OMH interventions met the inclusion criteria for this systematic review and were used as a source of primary studies.41-43 Three fully published articles from these sources met the inclusion criteria for this systematic review.22,44,45 The study quality was generally considered to be low because of the nonrandomized observational nature of the data,46 although the ASCO Expert Panel recognizes that random assignment of patients to an OMH practice versus a control practice would not be feasible or ethical. Key features of these interventions are included in Table 1, and study characteristics and cost outcomes are included in Table 2.

Table

TABLE 1. Key Features of Oncology Medical Home Interventions

Table

TABLE 2. Oncology Medical Home Comparative Studies: Study Characteristics and Cost Outcomes

One of the studies looked at the implementation of an OMH at four practices in Michigan.45 This intervention had payer support to implement a payment structure that tied reimbursement to outcomes and care quality, rather than drug costs. Initially, implementation was focused on the areas that were determined to have the highest potential for impact, including standardization of care, more comprehensive patient management, and early end-of-life discussions. Details of the intervention are included in Table 2. A second phase was planned to include a survivorship program, patient distress screening, imaging guidelines, and standardized patient satisfaction surveys. The RR of ED visits was 0.52 (95% CI, 0.32 to 0.83) and that of inpatient admissions was 0.32 (95% CI, 0.15 to 0.71) at year 1 following implementation (Table 3). Cost savings per patient was estimated to be $550 over the same time period. Kuntz et al cite many lessons learned, including the difficulty of incorporating many changes simultaneously; the most important change might have been for the oncology office team and the patient to accept responsibility for all patient care and ensure that this is recognized by the office team and patients.

Table

TABLE 3. Population: Oncology Patients at Four Michigan Oncology Practices (Kuntz et al45)

Waters et al reported outcomes from the COME HOME project. The study design used preintervention patients and matched controls as well as postintervention patients and matched controls from similar geographic areas. Although the absolute difference in spending for COME HOME patients before their intervention was $2,975 (CI, $1,635 to $4,315) greater than controls, COME HOME practices saw greater reduction in spending (P = .008). Pre- and postintervention differences in ED visits were also significantly improved (P = .024); however, the differences between postintervention patients and postintervention controls was not significantly difference (769 per 1,000 v 781 per 1,000, respectively [difference = –13 (95% CI, –76 to 51)]). Using the same methodology, there were no significant differences found on all measures of hospital admissions, inpatient LOS, or evaluation and management visits. The authors note that their analysis might have been underpowered to detect differences. They also point out that wide variation and unpredictability of treatment costs mean a lot of risk for specialty practices. Under these circumstances, financial targets may not be realistic. Boosting efficiency by focusing more on peak use times, improving information technology, and reporting were recommended as strategies to improve the OMH.

Colligan et al44 also conducted an evaluation of the COME HOME project, with a focus on end-of-life outcomes, although the model was not intended to directly address palliative care. In the last 30 days of life, participants in COME HOME had 57 fewer hospitalizations per 1,000 people and 11 ED visits per 1,000 more than patients in the control group (Table 4). Costs were reduced by $959, $3,346, and $5,790 in the last 30, 90, and 180 days of life, respectively. Statistical significance levels for these findings were not reported and could not be calculated on the basis of the available data. In another report by Colligan et al, COME HOME providers reported positive experiences with the implementation of triage protocols. In addition, 12 patients who were interviewed had favorable views of the triage service and enhanced access to the practices and appreciated the continuity of care.48

Table

TABLE 4. Population: Medicare Patients With Cancer Enrolled in the COME HOME Pilot Project (Colligan et al42)

In addition to studies that met the inclusion criteria, a perspective article describes an early Pennsylvania-based OMH that met the requirements for a level III NCQA PCMH. This intervention featured a physician-led care team to direct disease management, care coordination, the standardization of care to an evidence base, and patient engagement and education. With this model, ED visits were reduced by 68%, hospital admissions per patient treated with chemotherapy decreased by 51% per year, LOS for admitted patients declined by 21%, outpatient visits per patient-year in the general hematology oncology population were reduced by 22%, and outpatient visits per year in chemotherapy population were reduced by 12%. An estimated 1 million US dollars per physician per year in cost savings was realized.18

Clinical Pathways: Study Characteristics

Sixteen studies met the inclusion criteria for studies of pathway interventions (Table 5). Most studies were conducted in the United States,30,31,34,49-52,54,55 and others were conducted in Turkey,53,58 South Korea,56 Germany,57 Belgium,28 and China.27,59 Disease sites included breast,28,49-52,57,58 colorectal,55 lung,27,30,31 gastric,53,56 a combination of disease sites,54 or patients with bone metastases.34

Table

TABLE 5. Comparative Studies of Pathways in Oncology: Study Characteristics (Complete Outcomes Data Are Available in the Data Supplement)

The results were reported for a wide variety of settings including networks of practices,31 an National Cancer Institute comprehensive cancer center with a hub and spoke model,49 single institutions—either academic settings in the United States or internationally,27,28,30,34,50,56-58 or community-based practices.54,55 Some studies reported on large groups of patients from a single payer.51,52 A variety of data sources were used, including administrative data, chart abstractions, claims data, etc. The number of patients within studies ranged from 12 simulated patients from a single-institution study50 to more than 5,000 patients from a network of cancer centers.49 All studies were observational studies conducted without random assignment of patients to treatment or control groups. All studies were either a comparison of groups before versus after implementation of a pathway27,28,30,34,49,50,53,54,57,58 or contemporaneous studies of patients who were on pathway versus off pathway.31,51,52,55,56 Balance of study characteristics between intervention and control groups is reported in Table 5; some studies used statistical techniques such as propensity score matching to ensure that groups were balanced on characteristics such as age, stage, and extent of comorbidities.51-53 Study quality was generally rated as low because of reasons outlined in the section on OMH results; however, quality was upgraded to moderate where there was a large magnitude of effect.

Clinical Pathways: Study Outcomes
Appropriate use of therapy.

Several included studies demonstrated a significant increase in appropriate use of therapy post- versus prepathway implementation (Data Supplement):

  • In the study by Chapman et al,49 incremental modifications to the pathway resulted in an increase in the use of hypofractionated radiation therapy (HFRT). The adjusted RR of HFRT use was 7.9 (95% CI, 7.1 to 8.6) when the pathway was modified to include this as the preferred treatment option for women age 50 years and older, whereas it had previously been preferred for women age 70 years and older. There was also an increased RR of HFRT use compared with baseline when the pathway was further modified to include it as the only concordant option for women 50 years and older (RR, 10.7; 95% CI, 10.3 to 11.0).

  • In a study that used simulations of patient with breast cancer, unneeded tests were significantly reduced (RR, 0.69; 95% CI, 0.59 to 0.82) following the implementation of a pathway that was developed with multidisciplinary input. In addition, the authors of this study found significantly better adherence to preferred chemotherapy regimens. Rate of palliative care referrals was significantly improved over time for the 12-patient simulated breast cancer cohort (RR of referral, 6.77; 95% CI, 3.24 to 14.17).50

  • Also studying patients with breast cancer, Gautam et al52 found a significant decrease in granulocyte colony-stimulating factor use (attributed to reductions in the use of more toxic chemotherapy regimens) for patients on pathway versus off pathway (RR, 0.88; 95% CI, 0.83 to 0.92).

  • van Dam et al also found that the use of hormonotherapy in endocrine-sensitive invasive carcinoma and adjuvant chemotherapy in estrogen receptor–negative (PT1c+ or N+) invasive breast carcinoma improved significantly postpathway versus prepathway, with RRs of 1.15 (95% CI, 1.06 to 1.25) and 1.33 (95% CI, 1.02 to 1.72), respectively.28

  • Appropriate use of single-fraction radiation therapy for palliation of bone metastases increased from 18% before implementation of a pathway to 48% postpathway implementation (CI not reported).34

Length of stay.

Four studies assessed the impact of pathways on mean LOS:

  • There was a significantly reduced LOS for patients undergoing gastrectomy for gastric malignancy (11 days prepathway v 9 days postpathway [95% CI for mean difference, 1 day to 5 days]).53

  • One study of surgery for breast cancer reported a mean LOS of 4.5 days prepathway versus 3.4 days postpathway (95% CI for mean difference, 0.78 days to 1.5 days).57

  • A study of operable patients with breast cancer reported a mean LOS of 7 days prepathway and 4.1 days postpathway (CI not reported).28

  • In a study of patients with stage I-IIIA non–small-cell lung cancer, the total mean LOS declined from 20.76 to 19.34 days over the longer term (up to 2.75 years), whereas the postoperative mean LOS declined from 13.77 to 12.71 days over the same time period.27

Inpatient admissions or readmissions and ED visits.

In a study that included patients with breast, colon, and lung cancer, hospital admissions were significantly reduced postpathway versus prepathway (430 v 500 [95% CI, 100 fewer to 40 fewer]).51 In a study of patients with breast cancer, RR of postindex hospitalizations, ED visits, and avoidable hospitalizations was not significantly different for patients who were on pathway versus off pathway.52 The rate of readmission for infection, wound healing complications, and revision surgery pre- and postpathway for a population of patients undergoing surgery for breast cancer was under 5% for both groups.57

In Gautam et al,52 the lack of significant difference in quality indicators such as ED visits between on- and off-pathway patients, with a corresponding cost benefit for patients on pathway, led the authors to conclude that pathways should be recommended to improve efficiency without compromising patient outcomes. Feinberg et al attributed the significant reduction in hospital admissions in their multidisease site patient population to the encouragement of oncologists toward consistent and appropriate use of on-pathway chemotherapy regimens. This allowed oncologists to become more familiar with regimens' toxicity. In addition, the authors cited reduction in the use of complex chemotherapy in later-line treatment and avoidance of chemotherapy where its use was not evidence-based as contributing to reduced hospital admissions.51

Patient-reported outcomes.

Patients undergoing surgery for breast cancer reported good to excellent rates of patient satisfaction (> 90%) both before and after pathway implementation. Patient satisfaction improved significantly over time following pathway implementation in a study of patients with operable breast cancer.28 Another study of patient satisfaction rates in patients with breast cancer found that they were significantly improved after pathway implementation, as were anxiety level scores measured using the State-Trait Anxiety Inventory and QOL measured using the Short Form 36 Health Survey Questionnaire QOL scale.58

Complication rates.

Early postsurgery complication rates were significantly lower postpathway versus prepathway for a study of patients with gastric cancer (approximately 21% stage I, 17% stage II, and 60% stage III) who underwent elective surgery for gastric malignancy and followed a pathway for enhanced recovery after surgery.53 Another study of patients undergoing surgery for gastric cancer did not find a difference on versus off pathway in total complications for early-stage or advanced-stage patients.56 In a study of patients with non–small-cell lung cancer, complication rates declined significantly over time from 9.47% prepathway to 12.23% approximately 1 year after implementation and 8.38% up to 2.75 years after implementation; this analysis was adjusted for sex, smoking status, comorbidity status, procedure type, age, stage, and extent of resection.27

Among patients who started the gastric surgery clinical pathway in Jeong et al, only 19% followed it to completion, which may account for the lack of differences between groups. The CP was most commonly terminated for additional medical care and the development of postoperative complications related to the complexity of the surgery. The authors suggest allowances within the pathway for repeat orders or additional tests in anticipation of these developments. It was also noted that the length of postoperative hospital stay on and off pathway was the same; preoperative hospital stay was shortened on pathway; however, the authors attribute this change to a new policy of conducting preoperative examination and consultation at an outpatient clinic. In Güner, where the objective was to implement an enhanced recovery after surgery pathway, outcomes were favorable following pathway implementation.

Survival.

The hazard ratio (HR) for disease-free survival was significantly better for patients who were treated for colorectal cancer on pathway versus off pathway in a community practice setting (HR, 4.98; 95% CI, 2.11 to 11.74). OS for patients with metastatic disease was also improved for on-pathway patients within this practice (HR, 1.57; 95% CI, 1.04 to 2.39).55 There was no difference in OS pre- versus postpathway for patients with stage IV lung cancer (survival time: 10.7 [pre] v 11.2 [post], P = .08).30 Likewise, in an analysis of patients with non–small-cell lung cancer that was adjusted for age, sex, stage, performance status, and line of therapy, there was no significant difference in OS for patients on pathway versus off pathway.31

Jackman et al and Neubauer et al found that costs were reduced significantly without an effect on clinical outcomes such as OS. Neubauer et al note that in their study of patients with lung cancer in a community network, costs might have been lower because third-line therapy was not on pathway. Differences in OS in the study by Hoverman et al might have been due to case mix differences between on- and off-pathway patients; risk factor data were not available as context for this analysis.

Costs.

Eight of the included studies reported one or more outcomes related to cost of oncology care (Data Supplement). Cost savings were reported on most metrics across studies. Costs of adjuvant chemotherapy were generally found to be lower for patients on pathway versus off pathways. Several factors contributed to the reductions in costs of care:

  • Reduction in costs is attributed to reduction in length of hospital stay in one study of patients with breast cancer.57

  • Other drivers of reduced costs were reduction in the overall use of chemotherapy and less need for supportive granulocyte colony-stimulating factors because of less toxic options being preferred on pathways.52

  • Other studies reported reduction in costs because of decreased variability of chemotherapy.

  • Costs were reduced for chemotherapy and other medications on pathway in the first-line and adjuvant-line settings, but not the second-line settings in Neubauer et al,31 who also found that fewer supportive drugs are needed or prescribed for on-pathway patients who are receiving less toxic regimens.

  • No significant difference in costs for metastatic patients across disease sites on versus off pathway was considered to be a reflection of the low number of patients in this group who were on pathway.54

Barriers and Enablers to Pathway Implementation

In addition to process-, clinical-, and patient-reported outcomes, several studies discussed enablers and barriers to pathway implementation. These included the following factors that enabled the successful implementation of pathways:

  • Feedback on adherence and comparisons with colleagues can provide accountability for pathway implementation.35

  • Hyperlinks to the evidence base were considered helpful.34

  • The value of convening expert clinicians and scientists in a structured, ongoing process to discuss evolving issues around optimal cancer management cannot be understated.30

  • Integration within an electronic medical record.31

Challenges to the successful implementation of clinical pathways:

  • The upfront resource-intensive nature of clinical pathways.57

  • Purchasing pathways from outside vendors and not including enough members from inside the organization can contribute to a lack of ownership.35

  • The match between pathways and the patient is never exact, making it difficult to distinguish between unneeded pathway deviations and patient fit.35

  • In a review of a pathway that was designed to encourage the uptake of single-fraction radiation therapy for bone metastases, the following points were considered to be challenges:

    • Quantity of forms to fill out was identified as an issue that limited uptake;

    • Limited uptake because of lack of integration with an electronic medical record;

    • The pathway was not a mandatory component of workflow or otherwise incentivized;

    • The pathway did not include adequate life expectancy prognostication.34

Finally, some pathway studies described lessons learned with pathway implementation:

  • Pathways should be created through the input of a multidisciplinary team.30

  • van Dam et al28 emphasize the importance of training team members.

  • Reasons for going off pathway should require a strong justification (eg, expectation of toxicity, patient refusal, physician preference, patient anatomy, or comorbidities).

  • Neubauer et al31 recommend easy access to pathways, mandatory participation, and a prospective review process for pathway exceptions.

  • Creation of a clinical pathway is a resource-consuming process that may be best suited for higher-volume cases such as breast surgery.

Survivorship Cancer Plans

Eight systematic reviews were found that met the inclusion criteria for studies that assessed outcomes with SCP implementation compared with another intervention or usual care.36,60-66 The most recent systematic review (Hill et al36) was the most comprehensive and included the majority of studies included in the earlier systematic reviews; therefore, it was retained for inclusion and its results are discussed in greater detail subsequently.

Hill et al included eight randomized controlled trials in the first quantitative meta-analysis of patient-reported outcomes following implementation of SCPs, which were defined as interventions that included a summary of previous treatment and instructions for follow-up. The review included an additional 18 cross-sectional studies, seven prepost studies, and one longitudinal study published up to April 22, 2018. Across studies, breast cancer was the most common diagnosis (40%). Assessments by Hill et al using the QualSyst tool resulted in a high-quality evidence rating for studies included in the review.

The quantitative analysis by Hill et al showed no significant differences between survivors who received an SCP and survivors in the usual care or control groups on the following outcomes: perceived survivorship and cancer knowledge, physical functioning, satisfaction with information provision, self-efficacy, anxiety, cancer-specific distress, depression, and satisfaction with cancer follow-up. Insufficient data were available for assessment of outcomes by mode of delivery or tumor type. Across studies, the time to complete and deliver an SCP ranged from 20.6 to 90 minutes and 26 to 34.2 minutes, respectively. In the descriptive portion of their analysis, the authors found that evidence was inconclusive for most efficacy outcomes, although some studies demonstrated a positive effect on primary care providers' self-reported knowledge and confidence. The results for outcomes related to communication were also mixed, and SCPs may also improve survivors' adherence to follow-up care, although this association was not consistent across studies. Authors noted a lack of rigorously designed studies as a limitation of the review. Disease-related oncologic outcomes such as time to detection of recurrence were not included in this review.

In another review that included a similar group of studies to Hill et al, the authors found that it was difficult to draw conclusions about SCPs because most studies focused on the feasibility and acceptability of SCP delivery; although some beneficial effects were found, they were limited to single outcomes from single studies, and data collection tools and outcomes were inconsistent across studies.61

Data were not extracted from older systematic reviews that met inclusion criteria; however, these reviews, all based on a similar group of studies, did provide some additional interpretation of the data:

  • Studies have shown high patient satisfaction with SCPs,60 and survivors find them to be useful and helpful.36 Survivors also reported that treatment summaries were valued.63

  • Survivors continue to express unmet needs during care, including management of ongoing side effects and social and emotional needs as well as not knowing which provider was responsible for their care.63

  • Klemanski et al found that primary care providers felt that SCPs improved communication between themselves and the oncology team and that they valued receiving the record of care.63

  • Implementation of SCPs (including a treatment summary and plan for long-term follow-up) can be resource-intensive. Development of an SCP takes at least 1 hour and may take up to 4 hours, with the same amount of time needed when created by a doctor, nurse, or research assistant.60

  • In addition to time to create the SCP, other barriers included sustainability, lack of reimbursement, lack of consensus on format, and cost of documentation.63

  • Review authors noted the lack of clarity regarding who (eg, oncologist, nurse, or advanced practice provider) should develop SCPs, how they should be developed, and what they should include.62,63

Literature review interpretation and analysis.

A small number of studies were found that met the inclusion criteria for the systematic review of OMH. These studies, which describe an OMH that is modeled on the PCMH, provide modest data in support of the medical home model in oncology. A trend toward improvement in an outcome such as cost was demonstrated; however, longer-term data would be needed to establish the effects of the OMH more conclusively on patient outcomes and some analyses were underpowered to detect differences. Standards included in this article are based on the consensus of the Expert Panel, considering the results of published literature and previous knowledge of the PCMH model.

A larger volume of data was available for the targeted reviews of OMH subcomponents, including clinical pathways and SCPs, which allowed the Expert Panel to make more evidence-informed statements in these areas.

For the complete set of Standards, see the Bottom Line box. For documentation requirements associated with these Standards, please refer to the Data Supplement.

Defining a comprehensive program of oncology care delivery is first and foremost focused on quality of care. That said, care delivery is knitted to the costs of provision of care and to mechanisms of reimbursement. Hence, Standards that define OMH must also take into account issues important to the purchasers of care and be sensitive to the costs tied to implementing the model. Attention to the efficient and appropriate use of expensive oncology drugs delivered safely, efficient patient-centric care coordination and navigation of multidisciplinary oncologic care, and effective communication and planning related to symptom management and end-of-life care represent foundational aspects of quality in oncology practice as well as being the key aspects of care delivery that are important to purchasers of health care.

This document includes Standards for implementation of the OMH model of care. To the extent possible, these Standards were based on a systematic review of evidence; however, very few comparative studies of the OMH model were available to inform the Standards. As a result, these Standards are largely based on the consensus of the Expert Panel, while drawing from the foundational components of the original PCMH. Data were available to inform Standards for clinical pathways and SCPs, which are components of the OMH model that were identified by the Expert Panel as particularly resource- or cost-intensive. A review of these studies led to the inclusion of clinical pathways as a requirement in the Standards, recognizing that the current state of the art in oncology clinical pathways is focused on appropriate use of medical oncologics. This review is based on several studies that demonstrated positive results with this intervention, including an increase in appropriate use of care with pathway implementation. Documentation of evidence-based care in oncology is a keystone of quality oncology care—clinical pathways provide a mechanism of measurement that is a key to practice quality assessment. Pathways can also provide support to clinicians in integrating new information and evolving treatment options into clinical practice. That said, smaller practices face a significant challenge to implement a comprehensive clinical pathway program because of the resources necessary to do so. Data to support SCPs were less robust, leading the Expert Panel to conclude that SCPs should not be required, but rather that practices should demonstrate the process of survivorship care.

These Standards provide a roadmap for ongoing pilots to oncology practices and payers alike to define quality in oncology care delivery and a viable basis on which to build a value-based mechanism of reimbursement. The Expert Panel recognizes the significant investment involved with implementation of these Standards, and ASCO is in the process of enrolling practices in a pilot (Patient-Centered Care Certification Pilot) of the certification program, aimed at evaluating implementation of these Standards and demonstration of value and quality in a cancer care delivery model. These Standards are intended for use within this pilot program. The accompanying OMH Standards Manual (asco.org/standards) serves as a guide for implementation, while providing flexibility to accommodate individual practices. Any system of care delivery will evolve. Built into the OMH model is the requirement of ongoing quality improvement, which, along with learnings gained from implementation of the model, will drive modifications to meet patient and payer needs. Although the specification of quality measures is outside the scope of these Standards, the Expert Panel recognizes the value of measures in quality improvement. The OMH model is a care delivery model that can facilitate the design of measures that will enable quality improvement projects and meet external needs for outcome measures that may be required by government and/or payers.

Practices that implement the OMH model should be encouraged to share best practices and to publish their outcomes in peer-reviewed journals. In particular, data on longer time frames are needed to fully evaluate the impact of the OMH model. It is hoped that over time, the initial investment in the OMH model will result in more holistic patient-centered care, with demonstrated improvements in patient satisfaction, clinical outcomes, and overall cost of treatment.

The draft document was released to the public for open comment from September 21, 2020, through October 5, 2020. Response categories of “Agree as written,” “Agree with suggested modifications,” and “Disagree. See comments” were captured for the proposed Standards statements. The 20 respondents either agreed or agreed with slight modifications to all Standards statements, and changes were made to the wording of the Standards statements to incorporate the feedback received.

The draft was submitted to three external reviewers. Reviewer comments, such as input to the historical context of the OMH, were reviewed by the Expert Panel and integrated into the final manuscript.

© 2021 by American Society of Clinical Oncology

ASCO Board of Directors approval: January 21, 2021

Reprint Requests: 2318 Mill Road, Suite 800, Alexandria, VA 22314;

American Society of Clinical Oncology, 2318 Mill Rd, Suite 800, Alexandria, VA 22314; e-mail: .

Conception and design: All authors

Administrative support: Kim Woofter, Erin B. Kennedy

Collection and assembly of data: Ronda Bowman, Erin B. Kennedy, Carol Murtaugh, Dennis Zoet

Data analysis and interpretation: All authors

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

Oncology Medical Home: ASCO and COA Standards

The following represents disclosure information provided by the authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Kerin Adelson

Employment: Emilio Health/Brightline Health

Leadership: Emilio Health/Brightline Health

Stock and Other Ownership Interests: Lyra Health, MindNest Health, Carrum Health, Emilio Health/Brightline Health

Honoraria: Genentech

Consulting or Advisory Role: HERON, Celgene, Roche, AbbVie

Research Funding: Genentech/Roche

Patents, Royalties, Other Intellectual Property: Genentech

Travel, Accommodations, Expenses: Genentech, HERON, Celgene, Roche

Other Relationship: Genentech/Roche

Rachel Brodie

Honoraria: Discern Health

Research Funding: Amgen, Bristol Myers Squibb

Natalie Dickson

Employment: Tennessee Oncology

Consulting or Advisory Role: Via Oncology, AbbVie, Cigna

Research Funding: Bristol Myers Squibb

Travel, Accommodations, Expenses: Flatiron Health

Karen K. Fields

Stock and Other Ownership Interests: Pfizer, AbbVie

Honoraria: NCCN, NACCME, Pacific Group on Business, HMP, MJH Healthcare Holdings LLC

Consulting or Advisory Role: United Health Group

Speakers' Bureau: Genentech/Roche

Travel, Accommodations, Expenses: Genentech/Roche, CBI, Discern Health, Tapestry, NACCME, Cigna Health Care, FLASCO

Carol Murtaugh

Stock and Other Ownership Interests: Novocure, Almylan, Regeneron, MyoKardia

Consulting or Advisory Role: Coherus Biosciences, Amgen

Travel, Accommodations, Expenses: Coherus Biosciences, Amgen

Blase Polite

Honoraria: Physicans' Education Resource, Simon-Kucher and Partners, American Journal of Managed Care, HMP, Genzyme

Consulting or Advisory Role: Cancer Expert Now, Natera

Speakers' Bureau: Natera

Research Funding: Merck

Travel, Accommodations, Expenses: Tapestry Pharmaceuticals, Institute for Clinical and Economic Review

Open Payments Link: https://openpaymentsdata.cms.gov/physician/1196539/summary

Marcus Paschall

Stock and Other Ownership Interests: AbbVie

Dennis Zoet

Employment: Cancer & Hematology Centers of Western Michigan PC

Stock and Other Ownership Interests: Exact Sciences, AmerisourceBergen

Consulting or Advisory Role: Flatiron Health

John V. Cox

Employment: University of Texas Southwestern Medical Center—Simmons Cancer Center

Leadership: Parkland Health System

Stock and Other Ownership Interests: Amgen, Medfusion, Merck, Pfizer, Johnson & Johnson

Honoraria: Association of Community Cancer Centers (ACCC), American College of Physicians, NCCN, National Academies of Science Engineering Medicine

Research Funding: US Oncology

Travel, Accommodations, Expenses: American College of Physicians, Association of Community Cancer Centers (ACCC), NCCN

Other Relationship: Mary Crowley Research Center, Dallas Texas, ASCO, Texas Oncology

Uncompensated Relationships: National Committee for Quality Assurance

No other potential conflicts of interest were reported.

Table

TABLE A1. Oncology Medical Home Standards Expert Panel Membership

ACKNOWLEDGMENT

The Expert Panel would like to thank external reviewers Dr Barbara McAneny, MD; Dr Bhuvana Sagar, MD; and Dr John Sprandio, MD, for their insightful comments. ASCO and the Expert Panel would like to acknowledge Walter Birch; Brian Bourbeau; Bo Gamble; Piyush Srivastava, MD; and Elaine Towle, whose work greatly contributed to the development of these Standards and our ongoing collaboration to advance the Oncology Medical Home care model.

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ARTICLE CITATION

DOI: 10.1200/OP.21.00167 JCO Oncology Practice 17, no. 8 (August 01, 2021) 475-492.

Published online July 13, 2021.

PMID: 34255551

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