PARKVIEW CANCER 2017 ANNUAL REPORT

Transcription

1 PARKVIEW CANCER 2017 ANNUAL REPORT

2 A new approach to cancer care that puts patients first At the new Parkview Cancer Institute, patients will experience a calming, comfortable indoor garden totally separate from the clinical area. Cancer is a complex disease unlike any other illness or condition. From their initial diagnosis, patients begin a journey one that not only impacts them, but their families as well. Recognizing this journey and striving to make it less stressful to patients is the idea that underlies the Parkview Cancer Institute, opening in early We designed both the institute s physical building and the care processes it encompasses to create a new, forward-thinking approach to cancer care. Instead of copying an existing model, our team of medical professionals and leaders 2 I A new approach planned the Parkview Cancer Institute from the ground up. We visited leading cancer centers all over the country, meeting with administrators, patients and other physicians in all specialties. We continually asked one question: How can we do this better? As our team compared notes, a theme began to emerge the patient experience was at the center of what we all took away. If we could build on that, we knew we could build the best possible cancer institute. That s why you ll see such a laser focus on patients experiences in our new care model.

3 Table of Contents 4 Cancer specialists collaborate to expedite diagnosis and treatment plans 6 Nurse navigators guide patients through treatment and aftercare 8 Specialized care teams help patients fight cancer all in one place 10 Cancer program quality 11 Cancer Committee Members The team at the Parkview Cancer Institute will be with our patients every step of the way, supporting them in their journeys. From preventing the disease through diagnosis, treatment and survivorship, we meet patients where they are in their journeys and collaborate with them in an entirely new way. Over the past year, we ve worked hard not just on this building but also on the programs that support our patients. We ve built teams and care models that are truly revolutionary, incorporating the visions of patients as well as our complete range of care providers including oncologists, surgeons, nurses, dietitians, genetic counselors and many more. The new Parkview Cancer Institute embodies hope on many levels. We have hope that tomorrow s cancer care can be better than today s. And by advancing the cancer care provided in this region, our goal is to give patients and their families the gift of hope for longer, healthier lives. Neil Sharma, MD, President Parkview Cancer Institute Scott James, COO Parkview Cancer Institute Infusion bays in the new facility are designed to enhance patient privacy and comfort while allowing the patient to enjoy lots of natural light. A new approach I 3

4 Cancer specialists collaborate to expedite diagnosis and treatment plans A patient s cancer journey usually begins in a physician s office. The words You may have cancer trigger a flood of emotions that is a complex blend of fear and uncertainty. Patients and their families are often overwhelmed by the news. That s why we changed the way we do things in our new model of care. When patients are referred to the Parkview Cancer Institute, they won t be left on their own to navigate appointments with different specialists. Instead, our new care model wraps around them, meeting them where they are. A team approach Patients with known or suspected cancers are referred to one of our multidisciplinary tumor site teams, a group of surgeons, radiologists, medical oncologists, radiation oncologists, pathologists, registered nurses and other medical providers. Each team specializes in treating a type or group of cancers. Working together, the treatment team develops a plan for the combination of treatments that will lead to the best possible outcome for each patient. The team considers all of a patient s medical, physical and supportive care needs, along with other factors that may affect treatment. This innovative approach streamlines the diagnosis, staging and treatment plan for patients. The tumor site teams coordinate care, so patients spend less time waiting and can move into treatment sooner. At every step, the referring physician receives regular updates. The tumor site team concept facilitates collaboration and communication between all members of a patient s healthcare team. By meeting regularly to discuss advances in care, patient flow, processes and other new innovations, tumor site team members can constantly capitalize on new ideas to improve patients care. 4 I Cancer specialists collaborate

5 Tumor Board: Access to a team of experts Parkview Cancer Institute Tumor Boards include specialists from a variety of surgical and procedural specialties, medical oncology, radiation oncology, radiology and pathology who collaboratively review a patient s condition and determine the treatment plan. They meet regularly to discuss cancer cases and share knowledge. Determining a treatment plan Depending on the diagnosis, the tumor site teams take one of two approaches: + If it s cancer, the designated specialist on the tumor site team responsible for initial diagnosis & staging orders additional tests and scans, presents the case at the Tumor Board [see right], makes additional referrals to other physician specialists and schedules additional procedures. A nurse navigator [see page 6] contacts the patient to answer any questions and assist with needs such as coordinating appointments or connecting the patient with an oncology registered dietitian, a financial counselor or a social worker. The patient is then scheduled for initial follow-up in the clinic for review of the treatment plan. They are also provided an educational binder that details their diagnosis and treatment plan, and serves as a valuable resource during their cancer journey. + If it s not cancer, but rather a precancerous or low grade lesion that requires surveillance or preventive treatment, the primary care physician or other referring physician doesn t need to send the patient elsewhere. This single point of entry and coordination of care allows seamless transition for patients, reducing unnecessary visits and increasing communication between all members of the patient s healthcare team. Surveillance and prevention are a key aspect of Parkview Cancer Institute s goal to both prevent and treat cancer in all aspects. The patient may be monitored in high-risk clinics. The multidisciplinary model allows subspecialized cancer physicians such as interventional endoscopists/gi Oncology, breast surgeons, dermatologists, interventional pulmonologists focused on cancer care or other specialists to perform the appropriate surveillance and/ or surgical procedures to monitor and prevent future cancers. This is comprehensive, multidisciplinary cancer care at the next level. The Tumor Board s goal is to determine the best possible cancer treatment and care plan for an individual patient. Having fresh perspectives from other physicians makes it much easier to develop that plan. We provide sub-specialized expertise in surgery, medical oncology and other fields. We have highly specialized physicians in fields which may not be seen in other institutions who collaborate to attempt to find innovative solutions to your cancer. These include highly specialized fields such as gynecologic oncology, interventional endoscopic oncology, dermatology and orthopedic oncology. Additional supportive care providers such as genetic counselors, social workers and nurse navigators participate in the Tumor Board meetings as well. Through this multidisciplinary approach, patients gain access to a team of experts instead of relying on a single opinion. Cancer specialists collaborate I 5

6 Nurse navigators guide patients through treatment and aftercare As medical care becomes more complex, we want to keep things simple for patients at the Parkview Cancer Institute. To support patients as they go through the many stages of living with cancer, nurse navigators registered nurses with oncology-specific clinical knowledge play a central role in our care model. They serve as the direct line of communication for patients and their families, offering personalized assistance and making the overwhelming more manageable. Constant support, from diagnosis to aftercare Within hours of diagnosis, a patient meets with a nurse navigator from their tumor site team. This navigator follows the patient all the way through diagnostic testing, staging, treatment and survivorship, acting as a single, consistent point of contact who guides them every step of the way. Nurse navigators answer in-depth questions, explain planned treatments and coordinate care to ensure quality of life for patients and their families. This conciergelike level of service helps reduce patients anxiety and enhances their understanding of prescribed treatments. Though nurse navigators focus first on the clinical aspects of care, they also help patients manage nonclinical challenges. They address needs such as financial concerns, housing, transportation, prescription costs and much more. When needed, they access additional resources such as a social worker, financial navigator or psychologist. Advocating for patients Nurse navigators serve as important advocates for patients. They attend Tumor Board discussions, noting the practical aspects that need to be considered in a multidisciplinary treatment plan. They also give suggestions to the tumor site team on ways the care process can be enhanced from the patient s perspective. The heart of each nurse navigator s role is personalizing the care the Parkview Cancer Institute provides to patients and their families. By making the healthcare experience more patient-centered, nurse navigators allow patients to focus on achieving the best health outcome possible. 6 I Nurse navigators

7 Meet a nurse navigator As a nurse navigator with the Parkview Cancer Institute s breast care team, Amanda Turner, BSN, RN, works to pull together the many pieces of her patients treatment plans. My job is to help support patients through their cancer journeys, being available to answer questions about their plans of care and help provide resources and support when needed, explains Turner. I start working with referred patients immediately after their diagnosis or positive biopsy, she says. Within 48 hours, I call to introduce myself and the support team. I see them at their first surgical consult meeting and then at pivotal visits after that, all the way through their treatment plan. Nurse navigation team & social workers L to R: Jade Milliman, oncology social worker; Melissa Baker, RN, thoracic nurse navigator; Amanda Turner, RN, breast nurse navigator; Lauren Bodnar, RN, upper GI nurse navigator; Hilary Biddle, RN, GYN nurse navigator; Trudy Sloan, RN, thoracic nurse navigator; Tracy Busch, RN, lower GI nurse navigator; Carolyne Newburn, RN, hematology, sarcoma, melanoma nurse navigator; Tessa Shepherd, RN, GU nurse navigator; Michael Thurman, oncology social worker; Laura Hughes, RN, breast nurse navigator; Amy Solaro, oncology social worker...we treat each patient as a whole person. Every patient has different needs. Some need Turner s guidance to understand their treatment and how it works. So, her experience as an inpatient oncology nurse is invaluable. Others need help arranging affordable transportation to daily radiation treatments or help with wig fittings to cover hair loss from chemotherapy ( I encourage them to try all different styles, and we make it fun, she notes). As a nurse navigator, I follow patients from diagnosis to treatment completion, she adds. I tell them right from the beginning, You re stuck with me, which makes them laugh. We get to know our patients well, and they often express that they are glad to have had someone dedicated to them throughout their entire plan of care. With the approach we re using here, we treat each patient as a whole person, she says. In other words, someone who has a life outside his or her cancer diagnosis. Amanda Turner, BSN, RN Breast Nurse Navigator Nurse navigators I 7

8 Specialized care teams help patients fight cancer all in one place At the Parkview Cancer Institute, patient care is a team effort. Each of our patient care teams combines the skills and experience of multiple healthcare professionals, ensuring that patients receive the best possible treatment for their specific needs. This new approach improves coordination and decision-making between care professionals and reduces delays in treatment as well as referrals to services for patients. Each team focuses on one type of cancer Members of each multidisciplinary team specialize in diagnosing and treating one type of cancer, a model that typically exists only in large teaching institutions. We ve developed multidisciplinary care teams for tumors of the upper and lower gastrointestinal (GI) tract, breast, thyroid, thoracic, prostate, skin and sarcoma, as well as gynecology-related and hematology. For most cancers, the physician care team includes a surgeon, medical oncologist, interventional oncologist, radiation oncologist and other physician specialists, as needed. Each of these physicians brings a critical set of expertise and techniques for treating cancer. For example, the breast care team includes a dedicated surgeon, medical oncologist, nurse practitioner, nursing staff and nurse navigators. With its care team approach, Parkview brings a new model of care to our region. Team approach brings services to patients Even the physical structure of the Parkview Cancer Institute s new building will support our multidisciplinary care model. Instead of having to shuttle between different appointment times at multiple offices, patients will be seen in a single location. The building s design features care pods, where specialists from each care team come to the patient. Outside the patient exam/consult room, multiple specialists will collaborate on patient care. This design shifts the focus to the patient to align with the goals of our innovative care model. 8 I Specialized care teams

9 Linda Han, MD, and Ellen Szwed, DO, explain how Parkview s cancer care model is different Ellen Szwed, DO, medical oncologist, PPG Oncology, specializes in the care of patients battling breast cancer. Together with our breast surgeon, Linda Han, MD, PPG Oncology, nurse navigator and other clinical professionals, Dr. Szwed provides patients with a comprehensive plan for their fight against cancer. Breast Care Team L to R: Amanda Turner, RN, breast nurse navigator; Linda Han, MD, breast surgeon; Danielle Barker, RN, breast care nurse; Beckie Holdgreve, RN, breast care nurse; Ellen Szwed, DO, breast care medical oncologist; Krista Gaerte, RMA, care team medical assistant; Stefani Davis, DNP, breast care team nurse practitioner A seamless continuum of care Each multidisciplinary team takes patients through the entire course of their cancer treatments. Using the breast care team as an example, our team provides everything from breast screenings and prevention to diagnosis and treatment, all the way to survivorship. After treatment is complete, patients transition to a survivorship clinic. The clinic is run by an advanced care provider who teaches patients about developing a healthy lifestyle and guides them through what follow-up screenings should take place, which helps prevent other cancers or secondary cancer. Linda Han, MD PPG Oncology When she discusses the multidisciplinary care team model used at the Parkview Cancer Institute, Dr. Szwed points out its uniqueness in this region. This is the model being used in academic centers and large medical facilities around the country, she says. Outside of Indianapolis, there is no other place in Indiana where you can receive this kind of care. Dr. Han adds, It requires a deeper level of resources and commitment from the Parkview Health system because it focuses on patient care, not profit, she adds. The diagnosis of cancer is very overwhelming, and this approach, where we re all working together in one location, decreases the anxiety for that patient....it focuses on patient care, not profit. Ellen Szwed, DO Specialized Care Teams PPG Oncology I 11

10 Cancer program quality The Commission on Cancer s (CoC) Cancer Program Practice Profile Report (CP3R) provides information to accredited cancer programs on their quality and accountability metrics as compared to national benchmarks. The Commission on Cancer s Quality Integration Committee partners with internal and external specialized experts in the process of developing these quality measures. The CP3R measures provide the Cancer Committee with the ability to evaluate the care provided at our hospital as compared to national best-practice standards, as well as determine opportunities for improvement. They are meant to be used as an indicator of overall clinical practice, not for measurement of individual physician practices. There are several types of measures approved by the CoC: Accountability: This type of measure has a high level of evidence that supports it, including numerous randomized control trials. Quality Improvement: This type of measure is supported by evidence from experimental studies, not randomized control trials. Surveillance: This type of measure has limited evidence to support the measure, or it is used for informative purposes to an accredited program. It can be used to identify current trends in clinical care in the organization and help guide decision-making. In the chart below, we have included the most recent data (2015) from the Commission on Cancer for the Accountability and Quality Improvement measures where a national benchmark exists. In each of the measures, Parkview is at or above the national benchmark. CoC Parkview Measure National Benchmark Performance Rate Rate Colon Rectal Lung Lung Gastric Breast Breast Breast Breast At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. (Quality Improvement) 85% 97.60% Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is recommended for patients under the age of 80 receiving resection for rectal cancer. (Quality Improvement) 85% % Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pn1) and (pn2) NSCLC. (Quality Improvement) 85% % Surgery is not the first course of treatment for cn2, M0 lung cases. (Quality Improvement) 85% 89.50% At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer. (Quality Improvement) 80% % Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer. (Accountability) 90% 96.30% Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or Stage Ib-III hormone receptor positive breast cancer. (Accountability) 90% 95.90% Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >=4 positive regional lymph nodes. (Accountability) 90% 94.10% Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer. (Quality Improvement) 80% 93.30% 10 I Cancer program quality

11 2016 Total Cancer Cases Parkview Hospital This table represents the total number of cancer cases diagnosed and/or treated at Parkview Hospital in The table is categorized by primary cancer site and stage (extent of disease at diagnosis). Sites highlighted are Parkview s top 5 sites for STAGE Anatomic Site 0 I II III IV NA UNK Total % Total Head and Neck Lip Tongue Salivary Gland Floor of Mouth Gum and Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx Other Oral Cavity and Pharynx Digestive System Esophagus Stomach Small Intestine Colon Rectosigmoid Junction Rectum Anus, Anal Canal and Anorectum Liver Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Peritoneum, Omentum and Mesentery Other Digestive Organs Respiratory System Nose, Nasal Cavity and Middle Ear Larynx Lung, Bronchus - Small cell Lung, Bronchus - Non-small Cell Lung, Bronchus - Other Types Pleura Trachea, Mediastinum, Other Respir Bones and Joints Bones and Joints Soft Tissue Including Heart Soft Tissue Including Heart Skin Excl Basal and Squamous Melanoma - Skin Other Rare Skin Types Breast Breast (continued on next page) 2016 Total Cancer Cases I 11

12 STAGE Anatomic Site 0 I II III IV NA UNK Total % Total Female Genital System Cervix Uterus Ovary Vagina Vulva Other Female Genital Organs Male Genital System Prostate Testis Penis Other Male Genital Organs Urinary System Bladder Kidney and Renal Pelvis Ureter Other Urinary Organs Eye And Orbit Eye and Orbit Brain And Other CNS Brain Other CNS Endocrine System Thyroid Other Endocrine, Thymus Lymphoma Hodgkin - Nodal Hodgkin - Extranodal NHL - Nodal NHL - Extranodal Myeloma Myeloma Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia Other Myeloid/Monocytic Leukemia Other Acute Leukemia Aleukemic, Subleukemic and NOS Mesothelioma/Kaposi Sarcoma Mesothelioma Kaposi Sarcoma Miscellaneous Miscellaneous Totals Totals I 2016 Total Cancer Cases

13 Tumor Site Team Division Chairs Breast Linda Han, MD, PPG Oncology Upper GI Neil Sharma, MD, PPG Oncology Lower GI Sean Garrean, MD, PPG Colon & Rectal Surgery Hematology Robert Manges, MD, PPG Oncology Genitourinary Richard Zhang, MD, PPG Oncology Gynecologic Oncology Iwona Podzielinski, MD, PPG Oncology Melanoma Dara Spearman, MD, PPG Premier Dermatology & Skin Care Sarcoma Christopher Johnson, DO, Ortho NorthEast Thoracic Eric Peterson, MD, PPG Pulmonary & Critical Care Cancer Committee PHYSICIANS Neil Sharma, MD, Director, Advanced Interventional Endoscopy & Endoscopic Oncology, Parkview, President, Parkview Cancer Institute, PPG Oncology Sean Garrean, MD, Cancer Liaison Physician, Cancer Committee Chair, PPG Colon & Rectal Surgery Melissa Bosma, MD, FWRadiology Jeffrey Brown, MD, PPG Palliative Care and Parkview Home Health & Hospice Brian Chang, MD, Radiation Oncology Associates Doug Gray, MD, FACS, PPG Cardiovascular Surgery Richard Kelty, MD, PPG Family Medicine Seung Soo Kim, MD, Allied Hospital Pathologists Robert Manges, MD, PPG Oncology, Medical Oncology Stephen Schreck, MD, ENT Specialists Donald Urban, MD, FACS, Parkview Physicians Group Urology PARKVIEW STAFF Jill Branning, RHIT, CTR, Cancer Registrar/ Cancer Data Coordinator Andrew Byrom, Tumor Site Team Director Nancy Ehmke, RN, MN, AOCN, Oncology Nurse Specialist Mara Fisher, Cancer Conference (Tumor Board) Coordinator Diane Glass, Registered Dietitian Rae Gonterman, RN, MSN, VP Operations, Parkview Cancer Institute, Cancer Program Administrator Angela Horman, Supervisor, Outpatient Therapy Jackie Kintz, RHIT, CTR, Cancer Registrar Melissa Mishler, RHIT, CTR, Cancer Registrar Rebecca Nelson, MS, Genetic Counselor Amy Poole, RN, BSN, OCN, Director, Oncology Services, Community Outreach Coordinator Abby Reed, RN, Research Coordinator Jill Richey, MBA, BS, RT(T), Director, Parkview Radiation Oncology Tessa Shepherd, RN, BSN, OCN, Nurse Navigator Amy Solaro, MSW, LCSW, Psychosocial Services Coordinator Julie Thomas, RN, Quality Improvement Coordinator COMMUNITY REPRESENTATIVES Marsha Haffner, Director of Clinical Services, Cancer Services of Northeast Indiana Paul Moore, Health Systems Manager Hospitals, American Cancer Society This annual report was published in December It describes activities from throughout the year and reports 2016 Cancer Registry data. Cancer Committee I 13

14 Parkview Health Corporate Drive Fort Wayne, IN NON-PROFIT ORG. U.S. POSTAGE PAID FORT WAYNE, IN PERMIT NO Accredited as a Comprehensive Community Cancer Program by the American College of Surgeons since