Evaluating Palliative Care Impact: Insights From Tennessee Oncology’s OCM Participation

In an interview at the 2024 American Society of Clinical Oncology annual meeting, Ravi Parikh, MD, MPP, assistant professor of medicine and health policy, Perelman School of Medicine, University of Pennsylvania, discussed the outcomes of a palliative care study at Tennessee Oncology, providing insights into the challenges and limitations of evaluating hospice utilization and quality-of-life improvements in the real-world setting.

The American Journal of Managed Care (AJMC): You found no differences in quality of life or hospice use. Tennessee Oncology was already a longtime Oncology Care Model (OCM) participant; would you expect to see differences at a practice with a less robust commitment to value-based care?

Parikh: I’ll make 2 comments. First, we found reasonable numeric changes in hospice utilization. I think the reason they didn’t reach statistical significance is largely due to the fact that we powered the trial on palliative care referral, not on end-of-life care. So, we would need a larger, better powered study for end-of-life care to be able to comment on that. The rates of late hospice referral, the rates of the bad outcome decreased from 14% to 10%, which is a small, but I think, still a meaningful increase if this were integrated as part of a large value-based care model. 

We know that when palliative care is delivered in a structured, standardized way, in patient-level randomized trials, that it improves quality of life. So that’s not up for debate here. I think the question is in what we call an effectiveness study, which is in the real world, in large numbers of patients, where patients have the opportunity to refuse or accept palliative care, and more clinicians have the opportunity to opt in versus opt out of palliative care, do we see those quality-of-life benefits hold up? I would argue that we were largely unable to see that because patients didn’t fill out their quality-of-life surveys enough, because this is a real-world population, and patients could choose whether to do it or not.