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A physician engagement learning strategy to reduce care variation in breast cancer across a clinically integrated network.

30 Background: Advocate Physician Partners (APP) is a 5,000+ physician CIN associated with Advocate Aurora Health. APP wanted to standardize care among their 100+ medical oncologists who work in 20+ independent and employed practices. We approached standardization as a learning opportunity that could be best done through active engagement. Methods: From January 2016 to November 2017, we utilized the Clinical Performance and Value (CPVÒ) simulated patient platform to measure clinical practice and provide feedback across APP. Over six rounds, a total of 119 APP medical oncologists were scored against evidence-based work-up and treatment criteria. To determine if any of the learnings found on the CPVs translated into practice, we used registry and claims data on unnecessary imaging for early stage breast cancer. Results: In the simulated breast cancer patients, we found an overall improvement of 13.3% in primary diagnosis accuracy and 15.3% in treatment (p<0.001 for both). Preferred guideline-based hormonal therapy and chemotherapy similarly improved by 15.1% (p=0.018). To compare the CPV improvements with patient-level improvements, we looked specifically at unnecessary imaging and testing which declined overall by 35.7% (p=0.006); the associated costs fell by 31.3%. In early stage breast cancer, the CPV-measured use rates for CT or PET/CT (p=0.026) and other scans (p=0.012) decreased, showing better alignment with guidelines (see Table). When we analyzed the patient claims data, we found these showed similar declines in potentially unneeded breast cancer testing. Conclusions: Active learning, using CPV simulations, increased adherence to evidence-based practices, which translated into practice as evidenced by registry/claims data showing fewer unnecessary imaging in early stage breast cancer. [Table: see text]