title: Staff time and motion assessment for administration of erythropoiesis-stimulating agents: a two-phase pilot study in clinical oncology practices.
abstract: BACKGROUND
  Erythropoiesis-stimulating agents (ESAs) are used for the management of anaemia in patients with non-myeloid malignancies where anaemia is due to the effect of concomitant myelosuppressive chemotherapy. Assessing the impact of different ESA dosing regimens on office staff time and projected labour costs is an important component of understanding the potential for optimization of oncology practice efficiencies.
  
  
  OBJECTIVE
  A two-phase study was conducted to evaluate staff time and labour costs directly associated with ESA administration in real-world oncology practice settings among cancer patients undergoing chemotherapy. The objective of Phase 1 was to determine the mean staff time required for the process of ESA administration in patients with anaemia due to concomitantly administered chemotherapy. The objective of Phase 2 was to quantify and compare the mean staff time and mean labour costs of ESA administered once weekly (qw) with ESA once every 3 weeks (q3w) over an entire course of chemotherapy.
  
  
  METHODS
  Phase 1 was a prospective, cross-sectional time and motion study conducted in six private oncology practices in the US based on nine steps associated with ESA administration. Using findings from Phase 1, Phase 2 was conducted as a retrospective chart review to collect data on the number and types of visits in two private oncology practices for patients receiving a complete course of myelosuppressive chemotherapy.
  
  
  RESULTS
  In Phase 1, the mean total time that clinic staff spent on ESA administration was 23.2 min for patient visits that included chemotherapy administration (n(chemo) = 37) and 21.5 min when only ESA was administered (n(ESAonly) = 36). In Phase 2, the mean duration of treatment was significantly longer for q3w than qw (53.84 days for qw vs. 113.38 for q3w, p < 0.0001); thus, analyses were adjusted using analysis of covariance (ANCOVA) for episode duration for between-group comparisons. Following adjustment by ANCOVA, qw darbepoetin alfa (DA) patients (n(qw) = 83) required more staff time for ESA + chemotherapy visits and ESA-only visits than q3w patients (n(q3w) = 118) over a course of chemotherapy. Overall, mean total staff time expended per chemotherapy course was greater for patients receiving qw versus q3w DA. Weekly DA dosing was associated with greater projected mean labour costs ($US38.16 vs. $US31.20 [average for 2007-2010]).
  
  
  CONCLUSIONS
  The results from this real-world study demonstrate that oncology practices can attain staff time and labour costs savings through the use of q3w ESA. The degree of savings depends on the individual oncology practice's staffing model and ESA administration processes, including those that allow for optimized synchronization of patient visits for ESA and chemotherapy administration. These findings indicate that additional research using standard ESA administration protocols for longer periods of time with a larger number of oncology practices and patients should be conducted to confirm these findings.
authors.affiliation: RJM Group LLC, Crown Point, IN 46307, USA. john@rjmgroupllc.com
authors.forename: John F
authors.initials: JF
authors.lastname: Reitan
authors.forename: Arletta
authors.initials: A
authors.lastname: van Breda
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Corey-Lisle
authors.forename: Sanatan
authors.initials: S
authors.lastname: Shreay
authors.forename: Ze
authors.initials: Z
authors.lastname: Cong
authors.forename: Jason
authors.initials: J
authors.lastname: Legg
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000740:Anemia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D017048:Health Care Costs; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D018803:Models, Economic; D009819:Office Visits / Q000191:economics; D010561:Personnel Staffing and Scheduling / Q000191:economics; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D013996:Time and Motion Studies; D016526:Workload / Q000191:economics
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics
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