Cancer service line multidisciplinary cancer care assessment: Current state analysis and implications for tumor board redesign.

60 Background: Multidisciplinary approaches enhance cancer care quality. Multidisciplinary clinics (MDCs) and Cancer Tumor Boards (TBs) are two forums for a cancer service line to provide such care. At the 10 cancer centers in our system, MDCs and TBs independently evolved to meet local needs. Our goal is to elevate cancer care quality for patients and improve clinicians’ experiences providing multispecialty care in the network. Our first step was to inventory MDCs and TBs to identify gaps in establishing an integrated Multidisciplinary Care Model. Here we present the findings and implications for TBs. Findings for MDCs will be presented separately. Methods: An initial survey was sent to administrative and physician leaders at the two academic medical centers (AMCs) and eight community sites. Respondents had two months to complete surveys, with two reminders sent and the availability of structured interviews to facilitate completion. Results were compiled and shared with physician and administrative leadership of the Cancer Service Line. Results: Fifty-nine individual respondents were contacted across 10 sites. All sites returned surveys in the two-month period. Two facilitated interviews were needed to ensure completion. Fifty-three TBs were reported overall. Thirty three (20 and 13) occurred at the two AMCs; 20 in the eight community sites (median per community site 2.5, range 1 to 6). The two most common TB topics were Breast (2 AMCs, 6 community sites), and General (0 AMCs, 8 community sites). The frequency of TBs was most often weekly (30). All TBs included a virtual component. The most commonly desired change by TB leadership was more availability and attendance by specific subspecialty personnel; however, specific personnel needs varied by location and by tumor board. There was significant heterogeneity across other surveyed domains including who coordinated the tumor board, referral patterns, and documentation. Conclusions: We identified key areas for improvement including a need for long-term strategic planning to facilitate more consistent and equitable access to subspecialty opinions. Leveraging the common practice of virtual tumor board meetings, early efforts will include increasing availability of disease area specialists from the AMCs for two community sites to synchronously join virtual TBs, increasing access for all community medical oncology providers to refer patients or participate in AMC TBs, and phased implementation of the electronic health record (EPIC) TB tool which will standardize the landing page for case list submission, worklist including site of pathology and imaging, TB documentation, and integrated calendar TB schedules.