Abstract
Disclosure: A.I. Shariff: Consulting Fee; Self; Bristol-Myers Squibb. Speaker; Self; Merck. Background: Endocrine irAEs are noted in 4% to 14.6% of ICI treated patients leading to 12.2% of irAE related admissions.(1)Delayed access, diagnosis and management are often causes of preventable hospital admissions in cancer patient.(2 3) Herein, we describe a single-institution experience with an e- consult platform from oncology to endocrinology as a cost effective and high impact solution to this limitation. Methods: Between 5/1/2020 to 11/1/2021 patients who received ICI were included in a retrospective observational cohort study. Data collection included patient demographic, cancer, treatments, irAE and appointment specifics. Results: 102 e-consults were reviewed during the study period. Thyroiditis was noted as the most common irAE while NSCLC, and pembrolizumab use were most commonly noted in the cohort. 88 and 60 consults received diagnostic and treatment recommendations respectively. Reduction in median time to appointment was lowered from 60.5 days to 38.50 days. Among e-consulted patients, 2 (2.23%) required hospitalization for further evaluation and management. This is a reduction from previous data at the same institution (2007- 2017) where 11% endocrine toxicities were admitted. With an average length of stay approximated to 6.4 days at $3,142 per day, a total of $100,544 was saved as a result of the consult service.(1) We also noted that these e-consults were poorly reimbursed by all payers, and current average reimbursement ranged from $15- $32/ consult.(4)Conclusion: This study underscores the impact and effectiveness of e consults as a tool for timely recommendations and improving access leading to reduction in health care utilization. To support e-consults, the effort-payment mismatch must be addressed by health systems and payers that can propel integration and scalability of these effective services across oncology and other subspecialty practices to enhance access and mitigate gaps in specialty care provided to cancer patients. Presentation Date: Saturday, June 17, 2023