The HOPE Project: Improving Cancer Patient Experience and Clinical Outcomes Through an Integrated Practice Unit and Digital Transformation

SummaryFundación Jiménez Díaz University Hospital — a 651-bed teaching hospital in Madrid, Spain, which is part of the publicly funded, privately run Quirónsalud 4-H Network — developed and launched an initiative to incorporate technical innovation and an integrated practice unit (IPU) model to enhance care delivery for the more than 4,000 patients with cancer it serves annually. By 2021, the third operational year of the initiative, called the Hóspital Oncológico PErsonalizado (HOPE) project, the IPU was handling 75% of day hospital patients for chemotherapy-related care. Compared with 2018 preimplementation data, the first-to-subsequent appointment index (the number of appointments that are generated after a first appointment) was cut by 63% (to 6 from 16) (P < .001) due to the standardization of the appointments for each clinical pathway, better coordination between oncologists and nurses, and nursing empowerment to avoid redundancies in clinical tasks. The efforts have contributed to a reduction of oncologist appointments by more than 30,000 per year (to 16,280 in 2021 from 50,528 in 2018), while handling 4.25% more patients (to 1,616 from 1,549), cutting the overall process time from 10 hours over 3 days to just 2 hours in a single day at a single location, eliminating patient waiting-room time to 0 hours from 10 hours, and boosting patient Net Promoter Scores to 95 from 75. In terms of cost and efficiency, under the HOPE project model the average cost per cancer treatment has decreased 24%, and the number of patients who can receive treatment on a given day has doubled (60 vs. 30 patients). Importantly, data collection systematization and the early detection of adverse effects has contributed to a reduction in hospital admissions due to severe adverse effects or increased symptoms to 33% (525 of 1,615 patients) versus the 2018 rate of 58% (895 of 1,549 patients) (relative risk = 0.56 [confidence interval, 0.52–0.61], P < .001).