World Class Care, Close to Home 2014 OUTCOMES REPORT. Presenting 2013 Statistics. World Class Care, Close to Home.

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1 World Class Care, Close to Home 2014 OUTCOMES REPORT Presenting 2013 Statistics World Class Care, Cancer Institute Close to Home L e a r n m o r e a t w w w. F l a g l e r H o s p i t a l. o r g

2 Contents Chairman s Letter... 3 Breast Cancer Accreditation...4 & 5 Prevention Programs...6 & 7 Screening... 8 & 9 Education and Support...10 Patient Navigation...11 Community Needs Assessment...11 Statistical Analysis 2013 Data 2013 Registry Summary...12 Oncology Conferences...14 Follow My Health Patient Portal O U T C O M E S R E P O R T

3 Chairman s Letter 2014 On behalf of the Flagler Hospital Cancer Committee, I am happy to share the 2014 annual report. This year is particularly exciting because of two important accomplishments. First, the year was highlighted by achieving accreditation from the National Accreditation Program for Breast Centers (NAPBC). The NAPBC is a consortium of national, professional organizations focused on breast health and dedicated to the improvement of quality care and outcomes of patients with diseases of the breast through evidence-based standards and patient and professional education. We are one of only 547 centers in the United States to obtain this certification. The accreditation process involves meeting twenty-two evidence-based standards which cover a broad spectrum of processes and patient care from strict imaging guidelines to management of benign breast disease to multidisciplinary management of breast cancer. The breast program leadership team put in a tremendous effort and it paid off because we obtained the certification, with no deficiencies, on the first attempt. The second major event this year was achieving accreditation from the American College of Surgeons Commission on Cancer. The cancer program at Flagler Hospital was formally organized in 1999 and received initial accreditation by the Commission on Cancer in Re-accreditation takes place every three years and this was the first year the Cancer Program was judged on the 2012 patient-centered standards. The Flagler Hospital Cancer program was awarded a full three year accreditation with commendation in five areas. These five area include education of the registrars, annual report, pathology reporting, RQRS and accuracy of data submitted to the National Cancer Data Base. The reviewers from the NAPBC and Commission on Cancer each made numerous positive comments about our program. In particular, they were impressed by our Community Needs Assessment and the meaningful way in which this information was used to improve the health of our community. There was glowing praise for the breast cancer navigation program and how it was integrated into a community hospital and private practice setting. Finally, the reviewers noted the collegial atmosphere observed among the physicians and other health care providers and support staff. On behalf of the Cancer Committee at Flagler Hospital and all of the hard working individuals dedicated to cancer care, I present the 2014 Annual Report. Respectfully submitted, Marc A Warmuth, MD Cancer Committee Chairman and Cancer Liaison Physician O U T C O M E S R E P O R T 3

4 BREAST CANCER ACCREDITATION The Flagler Hospital Cancer Institute has been granted a three-year/full accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. During the survey process, the center must demonstrate compliance with standards established by the NAPBC for treating women who are diagnosed with the full spectrum of breast disease. The standards include proficiency in the areas of: center leadership, clinical management, research, community outreach, professional education, and quality improvement. A breast center that achieves NAPBC accreditation has demonstrated a firm commitment to offer its patients every significant advantage in their battle against breast disease. The survey process requires extensive preparation and consists of a comprehensive application and site visit by a physician surveyor. On October 8, 2014, Forrest Lee Tucker MD, met with Flagler Cancer Institute administrators and physicians to review the application and specific statistics related to patient care. Ultimately, the Flagler Cancer Institute was fully compliant with all 27 standards. Specifically, the Cancer Institute was commended for an exceptional Interdisciplinary Breast Cancer Conference and Patient Navigation program. Dr Tucker stated, The Flagler Hospital breast care team provides highly coordinated and compassionate care by an integrated team of well-qualified, experienced practitioners and managers. Particular strengths of this program include patient navigation and notably strong inter-specialty collaborative working relations. The leadership team is visibly supportive of the breast program O U T C O M E S R E P O R T

5 The NAPBC is a consortium of professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. This mission is pursued through standardsetting, scientific validation, and patient and professional education. Its board membership includes professionals from 20 national organizations that reflect the full spectrum of breast care. The American Cancer Society (ACS) estimated that there would be 232,340 patients diagnosed with invasive breast cancer in the United States in In addition, hundreds of thousands of women who will deal with benign breast disease this year will require medical evaluation for treatment options. Receiving care at a NAPBC-accredited center ensures that a patient will have access to: Comprehensive care, including a full range of stateof-the-art services A multidisciplinary team approach to coordinate the best treatment options Information about ongoing clinical trials and new treatment options And, most importantly, Quality breast care close to home. For more information about the National Accreditation Program for Breast Centers, visit their Web site at www. accreditedbreastcenters.org O U T C O M E S R E P O R T 5

6 Flagler Cancer Institute 2014 Public Reporting of Outcomes Standard 4.1 PREVENTION Programs Throughout 2014, the Flagler Cancer Institute facilitated numerous cancer prevention programs targeted to meet the needs of the community. Each year, breast, lung and colon are consistently ranked as top three cancer sites at Flagler Hospital and consequently the prevention programs aim to address these cancer sites. Further, a three year Flagler Cancer Institute Community Needs assessment was completed, which identified the following two specific areas of need within the community: mammography and age-adjusted death rate for black St. Johns County residents. Cancer prevention programs included presentations for local churches and civic groups, lung cancer awareness events, colorectal cancer prevention and awareness events and a skin cancer prevention program. In addition, Flagler Hospital partnered with other community organizations such as Good Samaritan Wildflower Clinic, American Cancer Society, Lung Cancer Alliance, Pink up the Pace and Unity Outreach to promote cancer awareness and early detection throughout the community. The following programs occurred throughout 2014: Breast and Colon Cancer Education Program: Throughout 2014, the Flagler Cancer Institute implemented a cancer prevention program titled ABCS for Community Health: An education initiative to address cancer disparities. The goals of the program were as follows: to address breast and colon cancer disparities within the African American community in St. Johns County; to encourage longlasting partnerships among community organizations; to encourage community members to engage in cancer preventative/ healthy behaviors; and, to develop community health educator champions that can serve as a long-term resource for members of their respective community. This cancer prevention program was funded through a Community Education grant from the American Cancer Society, and as a result of this program, the Flagler Cancer Institute recruited and trained 30 Community Health Champions. Each of these champions had existing relationships with historically African American communities and organizations and were able to provide cancer prevention education to 587 community members. In addition, the attendees were given information on local community resources to help increase access to cancer screening services. The following community partners served as a resource to the attendees: Pink Up the Pace, Good Samaritan Wildflower Clinic, North Florida Komen Grant for Breast Cancer Screening, Flagler Hospital, Imaging Center, Florida Department of Health Breast and Cervical Early Detection Program, St. Johns County Social Services, and the Azalea Clinic O U T C O M E S R E P O R T

7 Colon Cancer Prevention Programs: The annual Colorectal Cancer Awareness Day was held on March 27, The event was coordinated with Borland- Groover Clinic and GI Associates to provide information on colorectal cancer prevention and screening strategies. This event took place in the Cancer Education and Support Center and over 100 people visited the event and answered the optional survey. The information provided was based on the National Comprehensive Cancer Network (NCCN) Colorectal Screening Guidelines. Lung Cancer Prevention Programs: Quit Smoking Now is a smoking cessation program developed by ex-smokers for smokers. The group sessions are facilitated by the Cardiopulmonary department at Flagler Hospital once a week for one hour, over a six-week period. The group sessions cover different topics such as nicotine replacement therapy, stress reduction and relaxation techniques and identifying smoking triggers. Written material is provided, a toll free Quit Line is available, and people can re-enter the program as many times as necessary. Includes free nicotine replacement therapy. Throughout 2014, Flagler Hospital offered 14 free Quit Smoking Now classes. In total 141 Quit Smoking Now participants enrolled and 86 of the participants quit smoking. In addition to the Quit Smoking Now smoking cessation program, Flagler Hospital hosted two lung cancer awareness events. Shine a Light on Lung Cancer was held in the Cancer Education and Support Center on November 13, This is a national event held at different locations across the nation. The goal is to bring attention, compassion, hope and support to all individuals impacted by Lung Cancer. Lastly, the Great American Smoke out occurred on November 17 and 20, The event was hosted by Flagler Hospital in collaboration with Tobacco Free Florida and encourages smokers to make a plan to quit smoking or pledge to help someone quit smoking. Skin Cancer Prevention Program: Each year, the Flagler Hospital Cancer Education and Support Center partners with Students from the Flagler Hospital Academy of Medical and Health Careers at Pedro Menendez High School to host a local, Don t Fry Day. This year, the event took place on Friday, May 23, 2014, at St. Augustine Beach. Don t Fry Day is celebrated nationally the Friday before Memorial Day. Hospital employees and students distributed water, sunscreen and skin cancer information between 10:00am until 2:00pm. Approximately, two hundred members of the community were reached with bottled water, sunscreen, and skin cancer prevention handouts O U T C O M E S R E P O R T 7

8 Flagler Cancer Institute 2014 Public Reporting of Outcomes Standard 4.2 SCREENING Program In 2014, the Flagler Cancer Institute received a $15,000 grant from North Florida Susan G. Komen to provide breast cancer screening and diagnostic services to uninsured women in St. Johns County. The purpose of the program was to ensure equal access to quality breast cancer screening services. This was accomplished by using two different approaches. First, a one day screening mammogram and education event was held in collaboration with Good Samaritan Wildflower Clinic. This one day event targeted St. Johns County women ages who were not receiving any primary health care. The second approach, also coordinated with Good Samaritan Wildflower Clinic used a voucher system to support community members already receiving primary health care through Good Samaritans Wildflower Clinic. Through this program, 61 women have received a screening mammogram. Of the 61, 10 women required additional diagnostic testing and two required a biopsy. Ultimately none of the women screened resulted in a positive finding O U T C O M E S R E P O R T

9 The best protection is early detection Cancer Education and Support Center Hospital provides patients and their families with access to connects them with others who can help them through their cancer journey. In addition to a patient library, the CESC coordinates a variety of classes and support groups. In 2014, the Yoga, Meditation for Beginners, Psychosocial Distress Support Group, Art Class and the American Cancer Society 2014, the CESC also hosted a cancer survivor s day luncheon featuring a health and wellness fair and key note speaker. Over 50 community members participated in this event. Additionally, the CESC provides patients with the opportunity to utilize the wig and prosthesis lending closet. Patients have access to free wigs, hats and scarves. All items are free and donated by various groups and local community members including the American Cancer Society, the Saint Augustine Chapter of the American Sewing Guild, and Flagler Hospital Auxiliary. Interdisciplinary Breast Cancer Conference 2013, Patient Navigator, Cathy Conner, RN, BSN, BA, CBCN facilitated 22 Interdisciplinary Breast Cancer Conferences. A total of 146 cases were discussed, including 128 prospective cases and 18 cases represented for additional discussion. Physicians and other members of the breast care team review radiology and pathology comprehensive treatment plan based on evidence-based treatment guidelines and the opinions of multiple physicians O U T C O M E S R E P O R T 9

10 FLAGLER CANCER EDUCATION AND SUPPORT CENTER The Cancer Education and Support Center (CESC) at Flagler Hospital provides patients and their families with access to the latest information about their specific type of cancer, and connects them with others who can help them through their cancer journey. In addition to a patient library, the CESC coordinates a variety of classes and support groups. In 2013, the following classes and support groups were offered: Journaling, American Cancer Society Look Good Feel Better, Restorative Yoga, Breast Cancer Support Group and the Other Cancers Support Group. Significantly, on June 8, 2013, the CESC also hosted a cancer survivor s day luncheon featuring a health and wellness fair and key note speech delivered by Cindy Chaconas, founder of Pink Up The Pace. Over 50 community members participated in this event. Additionally, the CESC provides patients with the opportunity to utilize the wig and prosthesis lending closet. Patients have access to free wigs, hats and scarves. All items are free and donated by various groups and local community members including the American Cancer Society, the Saint Augustine Chapter of the American Sewing Guild, and Flagler Hospital Auxiliary O U T C O M E S R E P O R T

11 PATIENT NAVIGATION PROGRAM FOR BREAST CANCER PATIENTS The Breast Cancer Patient Navigation program began in 2008 and has supported over 650 patients and families. In 2012 alone, the patient navigator assisted 150 breast cancer patients. The Patient Navigator helps patients from the time there is a suspicion of breast cancer until treatment is concluded. Our patient navigator nurse is a Certified Breast Care Nurse CBCN and is dedicated to the following: providing patients with knowledgeable and compassionate support; facilitating communication between the patient and physicians in order to decrease fragmentation of care; and providing patients and family members with information on community-based resources. CANCER COMMITTEE COMMUNITY NEEDS ASSESSMENT In December 2013, the Flagler Hospital Cancer Committee completed a Community Needs Assessment. The purpose of the Cancer Committee Community Needs Assessment was to identify the needs of the population served, potential to improve cancer health disparities and gaps in resources for cancer patients. The cancer committee chose secondary data analysis as the tool for this assessment. Data gathered for this report includes data from the St. Johns County Health Leadership Council, Flagler Hospital Cancer Registry, US Census and FloridaCharts. Ultimately, the results of this needs assessment will be used to as building blocks for program development. Based on the data analyzed, the Cancer Committee elected to focus on the following top three priorities during : Mammography, Age-Adjusted Cancer Death Rate per 100,000 for Black St. Johns County, and Lung Cancer Diagnosis to Treatment Time Delays O U T C O M E S R E P O R T 11

12 2013 REGISTRY SUMMARY Fig 1a SITES ACCESSIONED IN 2013 Fig 1a SITE NAME NBR-CASES MALE FEMALE GUM OTHER/UNSPECIFIED PARTS OF MOUTH PAROTID GLAND TONSIL OROPHARYNX ESOPHAGUS STOMACH SMALL INTESTINE COLON RECTOSIGMOID JUNCTION RECTUM ANUS & ANAL CANAL LIVER & BILE DUCTS GALLBLADDER OTHER BILIARY TRACT PANCREAS OTHER DIGESTIVE ORGANS LARYNX TRACHEA BRONCHUS & LUNG BONES JOINTS & OTHER UNSPECIFIED SITES BLOOD & BONE MARROW SKIN RETROPERITONEUM & PERITONEUM CONNECTIVE SUBCUTANEOUS OTHER SOFT TISSUE BREAST CERVIX UTERI CORPUS UTERI OVARY PROSTATE GLAND TESTIS KIDNEY KIDNEY, RENAL PELVIS URINARY BLADDER MENINGES BRAIN OTHER NERVOUS SYSTEM THYROID GLAND OTHER ENDOCRINE GLANDS LYMPH NODES UNK PRIMARY TOTAL CASES O U T C O M E S R E P O R T

13 According to the 2013 ACS Facts and Figures, the projected estimate of new cancer cases in 2013 was 1,660,290. The national projection by gender was reported as follows: Male - 52% Female - 48% Flagler Hospital actual figures were as follow: Male % Female - 60% The Flagler Hospital Cancer Program, as well as the cancer registry was established in Presently, the registry database contains approximately 9,468 patient records, including benign and borderline central nervous system cases. In 2013, a total of 847 cases were entered in the database. The incidence table seen in Fig 1a depicts those patients who were initially diagnosed and, or treated at Flagler Hospital. Of the total caseload; breast, lung, colorectal, skin-melanoma and bladder, were the most frequently occurring malignancies for the reporting period, collectively accounting for 62% of the total analytic caseload; comparison with state and national figures are shown in Fig 1b. A key element of an approved CoC program is the ability to monitor the quality of patient care though cancer data collection and reporting via the registry database. Patient specific information in the Flagler Cancer Registry is closely monitored and continuously updated to reflect the most complete and accurate information regarding diagnosis, treatment, lifetime follow-up and outcomes. The registry staff extends a thank you to cancer program team members for their continued support, as well as to the physicians involved with the annual quality registry review. The registry has two certified professionals who remain continuously abreast of changes in state and national reporting requirements and guidelines, to ensure that valid, timely and reliable data are maintained. FLAGLER HOSPITAL CANCER CASES DIAGNOSED 2013 *NATIONAL COMPARISON OF THE FIVE MOST PREVALENT CANCER SITES * Estimated Cancer Cases from: The American Cancer Society Cancer Facts & Figures 2013 Fig 1b O U T C O M E S R E P O R T 13

14 2013 HOSPITAL WIDE MULTIDISCIPLINARY ONCOLOGY CONFERENCES tumor board sessions are an integral part of cancer care delivery and patient centered approach at Flagler Hospital ONCOLOGY CONFERENCE DISTRIBUTION fourth Wednesday of every month and are multidisciplinary in nature whereby initial work up, diagnosis, and treatment are reviewed and discussed. Cases may also be re-presented to discuss changes in quality of life. In addition, the tumor board forum serves as an educational component for physicians, as well as allied health professionals and are approved for continuing medical education and CEU credits. include prognostic factors and evaluate radiological as well as pathological stage is reviewed and derived when applicable, which enables the team to arrive at the most appropriate treatment recommendations according to nationally established guidelines. In addition, options for clinical trial participation are explored. in 2013 encompassed a wide variety of sites, including the most frequently diagnosed and, or treated at Flagler Hospital. During the reporting period, a total of 109 cases were presented. Of the total cases, 90% were discussed prospectively. All required disciplines were in attendance. Interdisciplinary Breast Cancer Conference Interdisciplinary Breast Cancer Conferences occur on the Navigator, Cathy Conner, RN, BSN, BA, CBCN facilitated 22 Interdisciplinary Breast Cancer Conferences. A total of 146 cases were discussed, including 128 prospective cases and 18 cases represented for additional discussion. Physicians and other members of the breast care team staging and treatment guidelines. Patients presented at each conference receive a comprehensive treatment plan based on evidence-based treatment guidelines and the opinions of multiple physicians O U T C O M E S R E P O R T

15 FOLLOW MY HEALTH PATIENT PORTAL In 2014, Flagler Hospital introduced its personal health record and patient portal to help patients achieve easy access to their records, from anywhere. Patients who provide an address upon admission receive an invitation to join the portal. Anyone can register, by logging on to org/followmyhealth Key information available includes: - Allergies - Conditions - Hospital Discharge Summaries - Visit Histories - Lab Results - Medications & Instructions Access your medical information on the go! Download the free portal app at your Apple or Android store. Enter FollowMyHealth in the search field. support@followmyhealth. com or call O U T C O M E S R E P O R T 15

16 Cancer Institute Health Park Blvd., St. Augustine, FL,