FOCUS ON QUALITY IMPROVEMENTS 2018 ONCOLOGY ANNUAL REPORT

Transcription

1 FOCUS ON QUALITY IMPROVEMENTS 2018 ONCOLOGY ANNUAL REPORT

2 TABLE OF CONTENTS TABLE OF CONTENTS CONTAINS ACTIVE HYPERLINKS. CLICK ON THE AREA OF INTEREST TO BE TAKEN TO THAT PAGE. CLICK BACK TO TABLE OF CONTENTS AT THE TOP OF ANY PAGE TO RETURN HERE. Baptist Health Lexington Welcomes New Cancer Specialists...1 Expansion of Financial Navigation Program...2 Cancer Committee Quality Studies Result in Improvements...3 Survivor Day Celebration...5 Employee Health Fair Focuses on Cancer Prevention, Screening and Early Detection... 6 Drug Take-Back Program...7 Oral Chemotherapy Clinic and Specialty Pharmacy... 8 Scalp Cooling System Introduced... 9

3 BAPTIST HEALTH LEXINGTON WELCOMES NEW CANCER SPECIALISTS BAPTIST HEALTH LEXINGTON CANCER SERVICES WELCOMES SHAUN MCKENZIE, MD, FACS AND JONATHAN FEDDOCK, MD In 2018, Baptist Health Lexington welcomed two new cancer specialists, Shaun McKenzie, MD, FACS and Jonathan Feddock, MD. Both physicians are highly respected in their fields and their addition results in expansion of services for patients undergoing cancer treatments. Dr. McKenzie joined Baptist Health Lexington as the new Medical Director of Cancer Services. Dr. McKenzie was previously a partner of Texas Surgical Oncology in Austin, Texas, where he held both national and regional leadership positions within the Sarah Cannon Cancer Shaun McKenzie, MD, FACS Institute and within Texas Oncology of Central Texas. Prior to his time in Texas, he was Assistant Professor of Surgery at the University of Kentucky and Director of the Markey Cancer Center Hepatobiliary Tumor Program. He has published extensively in the fields of surgical oncology and general surgery and has received numerous awards for teaching, mentorship and academics. While assisting in the growth of Baptist Health Lexington s Cancer Center, Dr. McKenzie intends to maintain an active clinical practice in surgical oncology as a partner with Lexington Surgeons. His focus will be in hepatobiliary, pancreatic and gastroesophageal surgery, along with laparoscopic surgery for abdominal tumors. Dr. Feddock is a boardcertified radiation oncologist who earned his medical degree with distinction from the University of Kentucky, where he also completed a radiation oncology residency. In his former role, Dr. Feddock served as an Associate Professor Jonathan Feddock, MD in the University of Kentucky s Department of Radiation Medicine and as Medical Director for the university s Markey Cancer Center Clinical Research Organization. He is a member of Alpha Omega Alpha Medical Honor Society, the National Cancer Institute, and the American Society for Radiation Oncology, and the Children s Oncology Group. His special interests include gynecologic, lung, gastrointestinal, pediatric and breast cancers, repeat radiation, new radiation techniques, advanced radiation implants and reducing long-term side effects. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 1

4 EXPANSION OF FINANCIAL NAVIGATION PROGRAM Financial toxicity is a term used to describe problems patients may experience with the cost of medical care. The direct costs of cancer treatments are high and the indirect costs are often unexpected. Examples of indirect costs include transportation, co-pays and lost time from work. The combination of direct and indirect costs result in the fact that cancer patients are more likely to experience financial toxicity than people without cancer. 1 Recognition of this issue was an important consideration in developing the role of financial navigators within the Baptist Health Lexington Cancer Center. The first Financial Navigator position was established in 2017 with a focus on oral chemotherapy treatment regimens. In 2018, a decision to expand the program was made and a second Financial Navigator position was added. The new position is focused on the needs of patients receiving chemotherapy infusions. with various means of financial assistance such as copay cards, discount cards, foundations, and manufacturer assistance. They may also help patients and providers complete and submit forms necessary to gain access to financial assistance. Financial navigators provide education and support regarding hospital and the insurance financial process. They assess for existing patient cancer insurance policies and they can help set up payment plans with billing departments. Although the financial navigators cannot take away all financial burdens from patients, they can provide vital education and resources to help minimize the burden and they seek to eliminate unnecessary financial burdens whenever possible. Both financial navigators address financial barriers to care and provide a range of services depending on specific patient needs and treatment. They function as advocates, educators, and liaisons as they seek to provide comprehensive financial education and support for the medical and gynecological oncology patients at the Cancer Center. In many cases, the financial navigator serves as a link between the patient, medical provider, insurance provider, pharmaceutical company, and the dozens of non-profit foundations providing potential assistance for patients in financial need. They may connect patients 1. National Cancer Institute: BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 2

5 CANCER COMMITTEE QUALITY STUDIES RESULT IN IMPROVEMENTS Each year, the Baptist Health Lexington Cancer Committee undertakes studies of quality with the aim of improving the quality of cancer care. In this report, two 2018 studies are highlighted, both of which resulted in quality improvements. Efficiency in any healthcare setting is a challenge and infusion centers that provide cancer chemotherapy and immunotherapy treatments are no exception. In 2018, the Baptist Health Lexington Cancer Committee studied a measure of efficiency and timeliness about patient wait-times between registration in the infusion department and the start of an infusion treatment. A national benchmark was used for comparison and standard practice was measured after which infusion department practices were reviewed. An action plan to improve coordination in the process of ordering chemotherapy was chosen as a focus for this project. After the intervention, the wait-time interval decreased by 13 minutes, benefiting both patients and the infusion center. Improvements will continue to be monitored and reported. A second quality study undertaken in 2018 focused on reviewing the incidence of emergency department (ED) utilization by patients being treated for cancer and on describing the reason for those ED visits. National benchmarks provided from The Centers for Medicare and Medicaid Services (CMS) were used in this study. CMS has adopted a new outpatient quality measure which goes into effect in The measure, OP-35: Admissions and Emergency Department Visits for Patients Receiving Outpatient Chemotherapy, is designed to assess the quality of care provided to cancer patients who have received chemotherapy in a hospital outpatient setting. In addition, the measure is intended to encourage quality improvement in cancer programs in order to reduce the number of potentially avoidable inpatient admission and ED visits for several conditions. These conditions are all described by CMS as potentially treatable in the ambulatory care setting (i.e. without utilizing the ED or inpatient hospital admission) and are the following: anemia, nausea, dehydration, neutropenia, diarrhea, pain, emesis, pneumonia, fever, and sepsis. While in some instances, it is appropriate and necessary for a patient to be seen in an ED or be admitted to the hospital, CMS identified these ten conditions as potentially avoidable through appropriately managed outpatient care and increased communication with patients. Under OP-35, the rate of patients with a diagnosis of cancer who have an inpatient admission or ED visit and have received hospital-based outpatient chemotherapy within 30 days at Baptist Health Lexington is compared to nationally observed rates. Reports are generated and will be provided by CMS at regular intervals. In this study, medical records of oncology patients who visited the emergency department within 30 days of receiving outpatient chemotherapy were reviewed. One full year of data was collected which consisted of a total of 82 ED encounters meeting the criteria. Results of the review indicated that the majority of patients who presented to the ED were older than 65, had advanced stages of cancer and the majority had existing comorbid conditions (i.e. heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, etc.). The most commonly seen cancer types were lung, non- Hodgkin s Lymphoma, breast and gynecologic cancers. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 3

6 On average, patients presented to the ED twelve days after receiving chemotherapy and 91.5% of those visits resulted in inpatient admission. Of the 82 patients, 25 were discharged with one of the ten qualifying diagnoses identified by CMS. Per the CMS reports provided to date, rates of ED or inpatient admission at BHLexington are not greater than national rates. Although Baptist Health Lexington practice fell in line with national comparators, our vision is to be a leader in clinical excellence, compassionate care, and quality care to meet the needs of our patients. As such, the results of this quality study have formed the basis for several improvements in the way we provide oncology care in the ambulatory setting. PRE-CHEMOTHERAPY EDUCATION AND ASSESSMENT VISIT Beginning in August 2018, all patients are scheduled for a Pre-Chemotherapy Education and Assessment Visit with one of our Advanced Practice Registered Nurses (APRNs) in the medical or gynecologic oncology clinic. During this visit, specific chemotherapy regimen and side effect education is provided. The education plan includes pertinent history and physical examination information for each patient. Psychosocial assessments are conducted at this visit and consults for additional resources and vascular access are completed. Early integration of palliative care and behavioral medicine are considered and integrated in the plan of care as appropriate. MEDICAL ONCOLOGY NURSE TRIAGE AND ASSIGNMENT OF CARE TEAMS A restructuring of the medical oncology physician clinic was completed. This initiative brought together dedicated treatment teams consisting of medical oncologist, oncology nurse, medical assistant and designated referral coordinator who all coordinate care for a particular patient. A new role for a Triage Nurse was also developed. The Triage Nurse is assigned to take patient calls for symptom complaints. This nurse is responsible for assessing complaints over the phone and communicating complaints with the physician and APRN. In the majority of cases, symptoms are managed over the phone and do not require an additional visit. In other cases, patients may be triaged to the ED or to the hospital or scheduled for a same-day visit in the Oncology Urgent Care Clinic. To assist with the Triage Nurses assessment, telephone assessment algorithms were developed for the following symptom complaints: Nausea and Vomiting; Fever; Rash; Diarrhea; Peripheral Neuropathy; Oral Mucositis; Dyspnea; and Constipation. APRN LED ONCOLOGY URGENT CARE CLINIC Identification of at risk patients, incidence and trends of ED utilization by oncology patients who received chemotherapy within 30 days of their ED visit prompted practice change within our cancer program. In August of 2018, Baptist Health Lexington launched an Oncology Urgent Care Clinic (OUCC). Patients are seen in the OUCC after they have called the oncology clinic with symptom complaints and after the Triage Nurse has determined the patient would benefit from being seen by an APRN. The OUCC was developed to provide early intervention for the management of symptoms with the goal of helping patients in the outpatient setting, thus decreasing the need for an ED visit and hospital admission. From August through November a total of 54 patients were seen by an APRN in the OUCC. To support the needs of patients being seen in the OUCC, the Outpatient Infusion department schedule was adjusted to allow for urgent treatments. To date, urgent infusion appointments have included administration of fluids, blood and blood products and the administration of medications such as antiemetics, antibiotics and pain medications. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 4

7 <<< B A C K TO TA B L E O F C O N T E N T S <<< SURVIVOR DAY CELEBRATION O n June 1, 2018, Baptist Health Cancer Center celebrated our cancer survivors and their families. There were several musical performers and refreshments including free Crank & Boom ice cream and other snacks. T-shirts were provided to everyone in attendance and survivor medals and sashes were given to all cancer survivors. Survivors were also treated to hand massages from the Baptist Health Lexington Wellness Center massage therapists. Health Lexington cancer survivor helped plan the event with Cancer Center staff, setting up the art display, as well as an exhibit of her own artwork. The planning committee started work in January and included several members of the Cancer Center staff. Feedback from the event was overwhelmingly positive and plans to continue the event as an annual celebration are in the works. The celebration also included an exhibit of art by our talented patients. Art is a medium of expression for those going through a cancer diagnosis and treatment and has been shown to be a healthy outlet. A Baptist B A P T I S T H E A LT H L E X I N G T O N / O N C O LO G Y A N N U A L R E P O R T / PA G E 5

8 <<< B A C K TO TA B L E O F C O N T E N T S <<< EMPLOYEE HEALTH FAIR FOCUSES ON CANCER PREVENTION, SCREENING AND EARLY DETECTION C olorectal cancer is the third most commonly diagnosed cancer in Kentucky. In 2018, the American Cancer Society estimates 2,370 Kentuckians will be diagnosed with colorectal cancer and approximately 830 Kentuckians will die from the disease. Several modifiable risk factors such as obesity and poor diet, as well as hereditary and medical conditions such as Lynch syndrome and ulcerative colitis, increase an individual s risk for developing colorectal cancer. Thankfully, early detection methods exist which can prevent colorectal cancer by finding and removing precancerous polyps, as well as detect cancer in its earliest stages, when treatment is most successful. A message of cancer prevention, screening and early detection was brought to the employees of Baptist Health Lexington by the Cancer Committee and Cancer Center staff during an employee health fair in April of The goal of the event was to educate employees on colorectal cancer prevention and colorectal cancer screening. The event offered education about cancer prevention through diet and physical activity, modifiable and non-modifiable risk factors for colorectal cancer and resources for risk reduction including exercise, diet, genetic counseling and bariatric surgery. Nurse Navigators, a Clinical Nurse Specialist, and Genetic Counselors were on hand to lead discussions with participants. A colon model, provided by the Kentucky Cancer Project, offered a visual aid for education about the normal anatomy of the colon as well as polyps and colon cancer. Eligible participants were also offered the opportunity to screen for colorectal cancer using a FIT test provided by the Kentucky Cancer Link. A FIT test, or fecal immunochemical test, is a screening test for colon cancer that looks for hidden blood in stool, which can be an early sign of cancer. All FIT tests returned for analysis were negative. The health fair attracted 413 participants who completed a knowledge survey immediately after attending the event. Future efforts will focus on the identified knowledge gaps. B A P T I S T H E A LT H L E X I N G T O N / O N C O LO G Y A N N U A L R E P O R T / PA G E 6

9 DRUG TAKE-BACK PROGRAM Baptist Health Lexington Retail Pharmacy, located in the hospital s North Tower, instituted a drug take-back program in The goal of the program was to provide a turn-key solution that is in compliance with the Drug Enforcement Administration Secure and Responsible Drug Disposal Act of Safe and convenient, green-colored, collection receptacles are located in the Retail Pharmacy. Unused medications may be placed in the receptacles and will be disposed of safely and without environmental contamination. In addition to the environmental benefits, drug-take back programs can decrease the risk of narcotic diversion and drugs being abused by others. Any unused or expired prescription of over-the-counter medications (including narcotics) and pet medications are accepted. Items and medications that are not accepted by the drug take-back program include illegal drugs, thermometers, inhalers, lotions/liquids, needles and aerosol cans. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 7

10 ORAL CHEMOTHERAPY CLINIC AND SPECIALTY PHARMACY Baptist Health Lexington s Oral Chemotherapy Clinic serves patients who are receiving one of the fastest growing forms of anti-cancer treatments. The National Comprehensive Cancer Network estimates that 25 percent of all oncologic agents prescribed will be oral chemotherapy by the year Oral chemotherapy is an expanding area of oncology that requires counseling, education, and follow-up as well as frequent monitoring for adherence, adverse effects, and interactions. The Oral Chemotherapy Clinic utilizes a board certified oncology pharmacist along with a financial navigator to streamline the education and financial resources provided to patients at Baptist Health Lexington as part of the multi-disciplinary approach to delivering care at our cancer center. All patients enrolled in the clinic receive education regarding their new treatment along with financial screening for assistance. Pharmacy services include initial education, follow-up toxicity checks, refill management, evaluation of drug-drug interactions, and management of side effects. Since the implementation of the Oral Chemotherapy Clinic in Feb 2017, over 645 patients have been enrolled in the program. Regular access to a pharmacist and financial navigator has resulted in improved timeliness of medication delivery and initiation of therapy. In order to provide local and consistent support for our patients, Baptist Health Lexington Retail Pharmacy fills oral chemotherapy specialty prescriptions when there is access to the medication and it is allowed by the patient s insurer. We have expanded accessibility to more medications through partnerships with national specialty pharmacies while still providing local pharmacy support and, beginning this year, began pursuing the development of a Baptist Health System-wide closed door, accredited specialty pharmacy. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 8

11 SCALP COOLING SYSTEM INTRODUCED Chemotherapy-induced alopecia is a visible sign of cancer treatment and is reported to be one of the most distressing side effects of the chemotherapy. 2 Scalp cooling has been used as a way of preventing or minimizing chemotherapy-induced alopecia. In the last several years, scalp cooling systems have received Food and Drug Administration (FDA) approval in the United States. One such FDA-approved system, Paxman Scalp Cooling System was introduced at Baptist Health Lexington in August 2018 with an initial focus on breast and gynecologic cancer patients undergoing treatment with the highest risk of alopecia. As of December 2018, seven patients have opted to utilize the Paxman scalp cooling system. Patients are educated about the system by Nurse Practitioners during the pre-chemotherapy education visit. If interested, eligibility criteria are reviewed, Patient post-cooling room made possible by a generous grant from the Lexington Cancer Foundation. 2 Polovich, M., Olsen, M., & LeFebvre, K.B., ( 2014). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice. Pittsburgh, PA: Oncology Nursing Society. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 9

12 additional information is provided, patients are fitted for a cooling cap and they are referred to a financial navigator for paperwork completion and financial assistance when needed. Scalp cooling is not usually covered by insurance; patients pay an out-of-pocket fee (based on number of chemotherapy cycles) and purchase their own personal, cooling cap. The cap is mailed directly to the patient s home and comes as a complete kit including a soft, flexible snug-fitting silicone cap, a neoprene cap cover that fits over the cap as well as additional supplies for scalp cooling hair preparation and for regular hair care. On the day of treatment, patients bring their cap and supplies with them to the infusion area. Nurses provide additional information and instruction and help the patient and family with cap application. The patient s cooling cap is connected to a base unit which circulates liquid coolant through the multiple channels in the cooling cap, thereby cooling the scalp. Inline temperature sensors ensure maintenance of an even temperature throughout the procedure. Coolant is circulated continuously throughout the chemotherapy treatment and for a post-cooling period after the chemotherapy infusion is complete. Scalp cooling works by decreasing the temperature of the scalp before, during and after chemotherapy administration. Vasoconstriction in the scalp results, reducing blood flow in the scalp and resulting in less chemotherapy being delivered to the hair follicles. Scalp cooling is not for everyone and results vary depending on the chemotherapy regimen, dose, and number of cycles. The goal of scalp cooling is to minimize hair loss as much as possible and to help alleviate this distressing side effect of chemotherapy. BAPTIST HEALTH LEXINGTON / 2018 ONCOLOGY ANNUAL REPORT / PAGE 10