59. A Novel Virtual Biologics Clinic Leads to Improved Patient Experience, Enhanced Research Recruitment and Cost Savings: Results of A Quality Improvement Project

Abstract

Background: A regional pathway for biologic prescribing in RA has been approved across Greater Manchester. The implementation and evaluation of the pathway represented a unique opportunity to develop the biologics service in a university teaching hospital. A quality improvement (QI) project was therefore initiated with the aim of improving patient experience, reducing treatment delays, increasing reliability of safety screening, increasing research recruitment and to realize cost savings in the biologics budget. A virtual biologics clinic (VBC) was established, with the aim of virtually reviewing all patients starting a biologic at Manchester Royal Infirmary. The main aim of this study was to assess the impact of the VBC on the above outcomes in all patients starting a biologic, using QI methodology. Adherence to the regional biologics pathway, and its impact on prescribing, was also assessed in RA patients. Methods: The QI team formed part of a scaled-down breakthrough series (BTS) to better understand processes and identify barriers in the current system. Plan-do-study-act (PDSA) cycles of rapid change were used in clinical settings to implement the changes. These changes included the introduction of a weekly VBC in August 2013 and the implementation of the RA biologics pathway. Novel documentation was produced and included an enhanced safety checklist and prescribing advice. All patients starting a new biologic were assessed virtually by a consultant rheumatologist, specialist nurse, specialist pharmacist and research nurse. Pathway adherence, safety screening, research eligibility were reviewed in the VBC, and prescriptions issued. PDSAs were conducted to refine the changes. Outcome measures were assessed weekly after implementation of VBC. Results: In the initial 14 weeks of the VBC, 40 patients were prescribed a biologic therapy (23 with RA), 100% were reviewed in the VBC. Mean treatment delay in all patients fell from 40.6 days (range 4-92) to 19 days (range 4-38) by week 14 and remains stable. Use of the enhanced safety checklist increased from 50% to 100% within 7 weeks, and remained universal at week 14. Recruitment of RA patients into research studies increased by 61% over the first 14 weeks, compared with the pre-VBC period. All patients initiating a biologic are actively considered for research. Adherence to the RA biologic pathway improved over the course of the QI project, and reached 90% by week 7. Annual cost savings to date, attributed to pathway adherence and enhanced research recruitment, is estimated at 51 300. Conclusion: Introduction of a VBC is an effective method to streamline the initiation of high-cost drugs, increase recruitment to interventional and observational studies and improve the reliability of pre-biologic safety screening. Significant cost savings can be achieved within 4 months and an estimated saving of 150 000 per annum for patients initiated on biologic therapy.