PathWell: The development of a triage center and access hub for comprehensive palliative care in oncology.

162 Background: Routine screening to identify palliative care (PC) needs, followed by assessment and management of needs is critical for high-quality cancer care. Our current healthcare system there is poor screening for PC needs, low referral rates to PC services, and unmet needs. In response to these gaps, we developed a dedicated triage center to streamline the assessment of PC needs and better connect patients with appropriate supportive care services.

METHODS: We identified 24 services at our academic cancer center that provide PC and supportive services. Examples include PC, psycho-oncology, survivorship, nutrition, and social work. Representatives from these groups convened to map service overlap and develop referral structures based on patient need and acuity. A triage hub (PathWell) was established to complete uniform assessments of patient needs and determine appropriate referrals. The hub utilized a centralized scheduling platform, new patient coordinators, and an oncology nurse for assessment and triage. Referrals to the hub were made via EHR, direct patient contact, or prompted by routine distress screening.

RESULTS: PathWell launched on February 1, 2016. Referral volume to the hub was 54 in February, 91 in March and 74 in April. Referrals from PathWell were distributed amongst the 24 services, the majority of referrals going to PC, psycho-oncology and nutrition. All programs that were part of the triage center experienced growth in volume; PC 41%, psycho-oncology 14%, nutrition 16%.

CONCLUSIONS: Partnerships between specialist services and dedicated triage staff can improve early access to resources for PC needs. Early data from PathWell reveals improved assessment and management of patient needs via referrals to appropriate services. The hub has also unveiled important resource gaps (e.g. physical therapy, integrative medicine). These gaps were not previously quantified, and thus not prioritized by leadership. Future state for PathWell includes reporting operational and health-related outcomes, optimizing distress screening, establishing care pathways for patient subtypes (e.g., metastatic disease), and hosting interdisciplinary tumor boards for complex distress management.