Mo1999 YOUNG PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA PRESENT WITH ADVANCED STAGE DISEASE BUT HAVE SIMILAR SURVIVAL COMPARED TO OLDER INDIVIDUALS

Background: Safety-net hospitals face challenges in the current healthcare model with having to balance costs while maintaining quality of care.Intervention: A large academic medical center with a medically-complex indigent patient population implemented a multidisciplinary approach to increase cost efficiency and improve quality of care: Pre-surgical (Optimization of pre-operative risks, Determination of suitability for planned procedure based on associated risk factors), Throughout hospitalization ( reducing post procedural complications such as venous thromboembolic (VTE) events and surgical site infection rates, Post hospitalization (Improved process of identifying post procedural complications, Enhanced awareness along with improved educational efforts related to occurrences via Mortality and Morbidity (M& M) conference) Results: A retrospective review of 81 consecutive colectomy cases for colon cancer from July 2016 to June 2019 was performed.The length of stay index across three fiscal years remained relatively constant despite an increase in case mix index (CMI).The mortality index within the cohort is 32.6% lower compared to other large, specialized medical centers with a relatively similar CMI (2.74 vs. 2.79).Over the same period, the direct cost index, mean direct cost, and mean total cost had declined with no significant impact to outcomes.The multidisciplinary interventions have led to a total savings of $229,376 over the two years.Conclusion: Integrated clinical pathway resulted in significant cost savings.Measures/resources to reduce length of hospital stay, readmission rates and ease of transfer of care is warranted to augment cost savings initiatives. Mo1999