Survivorship care at MSTI meets new standards, allows for patient engagement and satisfaction, and improves care coordination; costs are covered by reimbursement.
Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n = 152) were offered a genetics evaluation. In 2011 this improved to 70 % (n = 167), which was a statistically significant difference, X (2)(1) = 5.13, p = 0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X (2)(1) = 6.36, p = 0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60-80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.
203 Background: Defining and quantifying quality care is a challenge for cancer care providers. Since 2007 St. Luke’s Mountain States Tumor Institute (MSTI) has been participating in QOPI and was one of 23 practices that received the inaugural QOPI Certification in June 2010. The goal of participation is to benchmark MSTI’s performance with oncology practices across the nation and identify areas for improvement that are recognized as national quality standards. Methods: After each round of QOPI data abstraction, physician and administrative leadership selected measures with the greatest opportunity for improvement. Monthly chart audits for each measure were completed and the results were shared with individual staff to increase education and accountability. In Spring 2010, the education assessment in MSTI’s Electronic Medical Record (EMR) was redesigned to facilitate efficient documentation and data collection of smoking cessation counseling. In July 2011, the performance improvement (PI) team created “Quality Checklists (QCL)” in MSTI’s EMR for three different QOPI measures: i) signed chemotherapy consent, ii) smoking cessation counseling, and iii) assessment of emotional well-being. To ensure signed chemotherapy consent, one QCL included a reminder sent by the primary nurse or secretary to the chemotherapy infusion nurses. To ensure smoking cessation counseling and assessment of emotional well-being by social work, the other QCL included an alert sent by the new patient representative to the primary nurse and social worker. Results: Signed chemotherapy consent improved from 10% (n=229) in 2007 to 100% (n=117) in 2012. Smoking cessation counseling improved from 13% (n=40) in 2007 to 93% (n=272) in 2012. Assessment of emotional well-being improved from 78% (n=302) in 2007 to 95% (n=120) in 2012. Of the patients that had problems with emotional well-being, 73% (n=55) in 2007 had their problems addressed and 95% (n=41) in 2012. Conclusions: QOPI has provided MSTI with the initiatives and benchmarks to quantify quality cancer care. By combining participation in QOPI and ongoing PI data collection, analysis, and action plan implementation MSTI has enjoyed marked improvements in quality.
97 Background: Advances in genetics are rapidly changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this high risk patients and families who qualify for genetic counseling are not referred; this is due to increasing responsibilities on physicians. Genetic counselors could be utilized to review new oncology charts to improve identification. Methods: A genetics assessment tool developed by NCI Community Cancer Centers Program generated baseline measurements of 2010 tumor registry data of patients meeting NCCN guidelines for genetics evaluation. A weekly list of new oncology patients was provided to a genetic counselor who reviewed each H&P dictation focusing on the pathology, age, and family history sections. The genetic counselor notified the oncologist by email or through the EMR system, and the physician discussed genetic counseling with patient or approved the order. Post implementation of the chart review program was measured using 2011 tumor registry data. Results: In 2010 58% of total applicable patients were offered a genetics evaluation. In 2011 this improved to 70%. Based on disease type: 69% (breast), 59% (colon), 29% (ovary), and 20% (uterine) were offered a genetics evaluation in 2010. In 2011 these numbers were 76% (breast), 64% (colon), 91% (ovary), and 20% (uterine). Over a 10-month period a total of 122 patients were identified through the chart review program by the genetic counselor. Three of these were confirmed to have a genetic mutation for one of the hereditary cancer syndromes. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, 4 pediatric oncologists, which generated 60 to 80 minutes of work weekly for the counselor. Conclusions: This program improved patient identification and allowed physicians to become more aware of opportunities for genetic consultation that led to a streamlined referral process and allowed more applicable patients to receive counseling and testing. Project funded in whole or part with Federal Funds from the National Cancer Institute, National Institutes of Health, Contract No. HHSN261200800001E.
32 Background: New 2015 Commission on Cancer (CoC) standards require that all patients who complete treatment receive an individualized survivorship care plan (SCP). To meet this new standard St. Luke’s Mountain States Institute (MSTI), with support from the NCCCP, implemented a process that is multidisciplinary, efficient and sustainable. Methods: At MSTI, the patient’s SCP is a modified ASCO template with a comprehensive care plan and is prepared in the EMR by a Registered Health Information Technician (RHIT). This document is reviewed during a one hour visit with a nurse practitioner and a social worker. The patient participates in the discussion and sets wellness goals for healthy survivorship. The provider’s dictation is mailed to the PCP with the SCP. From Aug. 2011 – June 2012, 53 breast cancer patients were seen in 1 hour joint nurse practitioner/social work survivorship visits. A chart audit was conducted for these patients and follow-up phone calls were done with 36 patients at one month post-visit to evaluate patient understanding and satisfaction. Financial analysis was also completed to determine return on investment (ROI). Results: From chart review, the most common patient concerns were nutrition and weight loss (36%), anxiety (23%), fatigue (21%), depression (17%), caregiver stress (19%) and sexuality (17%). Phone calls showed high patient satisfaction and understanding. Patients rated the following statements on a Likert scale from 5=strongly agree to 1= strongly disagree: I understand my treatment summary and care plan 92% strongly agree or agree, I feel the survivorship visit met my survivorship needs, 97% strongly agree or agree, and 76% of participants were still working on wellness goals at one month. Patient accounts were reviewed showing approximately 50% ROI. Conclusions: It is possible to implement sustainable and comprehensive survivorship care that meets the new CoC standards. The model at MSTI provides increased patient engagement, patient satisfaction, and improved patient provider communication in addition to ROI. Opportunities remain to measure long term health outcomes and downstream revenues associated with this survivorship model. Project funded with Federal funds from the NCI, Contract No HHSN261200800001E.
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