3 research outputs found
Establishing survivorship care planning in a comprehensive cancer center to meet clinic needs and accreditation standards
59 Background: Standard 3.3 of the American College of Surgeons Commission on Cancer (CoC) patient-centered care guidelines requires that accredited institutions deliver SCPs to all patients completing cancer treatment with curative intent (10% of eligible patients in 2015 and increasing incrementally to 100% in 2019). Implementation of SCP delivery has been challenging and limited to date. We describe our implementation process at the Robert H. Lurie Comprehensive Cancer Center. Methods: We established a multidisciplinary working group that developed and administered a survey of providers’ attitudes towards SCPs and preferences for delivery, assessed clinical workflows, then developed and vetted customized SCP templates within the electronic health record (EHR) and two complimentary SCP delivery models. Results: Twelve providers completed the survey (6 physicians, 5 advanced practice providers [APPs], 1 nurse). 67% viewed SCPs as feasible within workflows, 75% felt designated survivorship clinicians were best equipped to deliver SCPs; All reported SCPs were beneficial to patients; and 92% felt SCPs were beneficial to inter-provider communication. Cited barriers were: time and staff required and non-optimal billing. To harmonize with existing workflows, we established two delivery models: (1) clinical groups with a low volume of survivors relative to available nursing staff complete and deliver SCPs themselves; (2) clinical groups with high volumes of survivors relative to available nursing staff refer patients to a centralized survivorship clinic where SCPs are delivered by designated survivorship APPs. All elements of the ASCO templates were incorporated into our EHR templates. We reduced free-text data entry by designing templates where 20% of the fields are auto-populated from existing EHR data and another 65% use drop-down menus. Mean completion time is 12 minutes (range 10-30 minutes; n= 30). Conclusions: CoC-accredited institutions across the nation are working to meet Standard 3.3. We present our experiences developing and implementing SCP delivery models, including lessons learned to inform models of survivorship care under development at other institutions
Survivorship care planning in a comprehensive cancer center using an implementation framework
Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation
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Use of a best-practice advisory to increase survivorship clinic referrals
53 Background: The American College of Surgeons Commission on Cancer require accredited institutions to give patients a survivorship care plan (SCPs) within six months of completing curative intent therapy. However, only a minority are receiving SCP’s. Some institutions have survivorship clinics to deliver comprehensive care, including SCP’s. Insufficient referrals to such clinics are a common barrier due to survivorship not being integrated into oncology workflows. To address this, we developed and implemented a best practice advisory (BPA) alert within our EMR to identify eligible patients and facilitate referrals to the survivorship clinic. Methods: Our pilot included breast cancer patients within medical oncology. The BPA electronic alert criteria included: stage 0-III, new patient encounter within 12 months, no SCP completed or previous referral. Upon triggering, the BPA asks “Does your patient require a SCP?” followed by 3 options: 1) SCP needed- an automatic order is generated, if signed, the BPA will not fire again, if unsigned, it will fire at the next encounter (no sooner than 30 days) and will continue until an order is placed or the response “ SCP not needed” is selected. 2) SCP not needed- the BPA will never trigger again for that patient. 3) Don’t know/still on treatment-the BPA will re-fire in 30 days. Data on frequency of BPA firing and number of referrals was compared 90 days prior and post implementation. Chi-square analysis was used. Results: Between 4/1/2015-3/31/2016, 902 patients were seen with stage 0-III breast cancer at Northwestern. Ninety days prior to implementation of the BPA, 30 patients (3.3%) were referred by 8 oncology providers. In the 90 days following implementation, the BPA fired 845 times (48.5% option 1, 24.8% option 2, 26.6% option 3) and 198 patients (22%) were referred. The difference was statistically significant ( χ2 = 141.7, p < 0.0001). Conclusions: The implementation of BPAs within an EMR is an effective way to increase referrals to a survivorship clinic, thus increasing the number of patients given SCPs. Challenges identified were having enough staff availible to deal with a rapid increase in referrals, need for refinement of BPA criteria to more precisely identify eligible patients, and provider burden