LAUSR

83 Background: Hospice enrollment (QOPI measure 42) has consistently been lower in practices in the Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly all medical oncology practices. MOQC enrollment has been 47% during CY2014-18 compared to national QOPI, which ranged from 53 to 59% during the same time period. We describe our approach to improve hospice use in the care of oncology patients. Methods: MOQC providers suggested that hospices across the state be involved in facilitating patient-centered approaches to increase enrollment of patients to hospice care. Beginning in Spring 2018, hospices in each of the six MOQC regions were invited to participate in standing regional meetings as well as teleconferences (one per region). Root cause analyses identified barriers universal and specific to that region. Each region was asked to choose at least one hospice-oncology project. Results: Thirty hospices are participating, including the five largest hospices in the state and hospices associated with the largest healthcare systems. Barriers to hospice include lack of hospice services in rural areas, in complete understanding among oncologists about what hospice can provide, resistance from patients and families due to misperceptions, communication issues with oncologists, between practices and hospices, and/or with patients once referred to hospices, lack of appreciation by hospice providers regarding the long standing relationship between patients and oncologists, and variation in use of palliative treatment such as radiation therapy. A total of 13 projects have been selected by the hospices and oncology practices to be developed by the regions. Once harmonized by the Coordinating Center, the projects will be shared across the state. The Coordinating Center is addressing lack of access to hospice in remote rural areas. Conclusions: Our partnership between oncology practices and hospices across a statewide collaborative has been a mutually beneficial relationship that promises to address some of the key systemic barriers to hospice enrollment. Feedback has indicated that communication between oncology and hospice providers is becoming more seamless and that referrals to hospice have increased.