Variance In Multidisciplinary (Multid) Recommendations In A Conference Only Vs Co-Located Clinic Model

e18039 Background: New MultiD models can provide healthcare systems with improvements in care for high risk populations. Deviation from MultiD recommendations has been associated with worse survival in lung cancer patients. We compared the concordance rate of recommendations developed out of a MultiD conference for patients who were seen or not seen within a co-located MultiD clinic. Methods: From 2014 to 2015, NCCN guideline driven recommendations for care, generated out of a weekly MultiD conference for patients seen and not seen within a co-located clinic were prospectively recorded. MultiD case recommendations were communicated to the relevant clinical care providers by verified closed-loop communication, within 48 hours of review. After an interval of 30 days, we recorded the concordance between MultiD recommendations and actual care provided, and categorized the causes of discordance into 3 areas: provider-, patient-, or insurance-induced. We used the Fishers Exact test to compare the discordance rate of patients seen within the co-located clinic vs those not seen in the co-located clinic (conference-only model). Results: The discordance rate in the co-located model (n=182) was 6%, compared to 17% in the conference only model (n= 184) (p=.002). In both models, approximately 50% of the discordance was patient-induced, and 50% was provider induced (Table 1). The greatest amount of discordance occurred among recommendations for additional biopsy, additional radiologic studies, and definitive treatment. Conclusions: Even with closed-loop communication with providers, the conference only MultiD model of care was associated with a threefold higher discordance rate than care in a co-located clinic (Table 1). The cause of discordance was proportionally similar. Further careful evaluation of models of MultiD care is needed. Variable Conference Only Patients N=184 Co-located Clinic Patients N=182 p-value Mean Age (years) 62 64 N.S. % Private Insurance 48 42 N.S. % African American 29 40 0.02 % Female 56 56 N.S. % Stage III/IV 58 63 N.S. % PS: ECOG (0) 69 63 N.S. % Adenocarcinoma 52 56 N.S. % Discordance rate 17 6 0.002 % Patient Induced 50 55 % Provider Induced 50 45 *Only significant values (p<0.05) given.