Creating a Survivorship Model of Care

Transcription

1 Creating a Survivorship Model of Care JULIE A SPEARS APRN-CNS, CCNS, A OCNS, DNP

2 Objectives Discuss the meaning of survivorship care. Describe the purpose of a survivorship care plan. Explain the benefits and barriers in providing survivorship care.

3 Survivorship There are approximately 14.5 million cancer survivors alive in the United States and that number is predicted grow to nearly 19 million by 2024 (American Cancer Society, 2014). The need for survivorship care stems from a larger aging population, earlier detection, and improved treatment (American Cancer Society, 2016).

4 Complex Survivor Needs Information Physical Issues Psychosocial Issues Management of long-term/late effects Surveillance

5 Quality Organizations Institute of Medicine (IOM): 2005 landmark consensus report. Commission on Cancer (COC): 2012 updated standards for accreditation. Quality Oncology Practice Initiative (QOPI)

6 Survivorship Care Plans The Institute of Medicine recommends oncology patients receive a survivorship care plan (SCP) at the conclusion of treatment to facilitate: Communication between providers Document information about treatments administered Provide follow-up guidelines including additional screening Discuss symptoms of late effects from treatment or signs of recurrence (Hewitt, Greenfield, & Stovell, 2005).

7 Background Despite more than 10 years of advocacy by the IOM and numerous studies on survivorship, the benefits of providing the SCP are still unclear. Use and development of SCP Models of care Few measurable outcomes

8 Barriers Preparation and review of the SCP with the patient requires extensive resources and information which is rarely efficiently integrated into the electronic medical record (Parry, Kent, Forsythe, Alfano, & Rowland, 2013). No clear financial incentive for survivorship care (Balogh et al., 2011).

9 Models of Care Models of care for survivorship have been defined as a broad and holistic approach to follow-up care for cancer survivors, addressing multiple needs (Halpern et al., 2014, p. e19). Components used to guide a model of care include patient characteristics, organizational structure and setting, provider responsibilities, payment consideration, and risk stratification

10 Framework The cancer survivorship experience has been defined as an experience that begins at diagnosis and continues for the length of the patient s life (K. Miller, Merry, & Miller, 2008)

11 Program Description

12 Methods Sample: Convenience, over 18 years of age, breast cancer, patients at Oklahoma Cancer Specialists and Research Institute (OCSRI) between 2013 and 2015 with 25 patient in the experimental group and 25 in the control group. After IRB approval, two reviewers collected data independently from each group.

13 Results The physician and APRN team had notable fewer triage calls than the control group which may indicate better symptom management. The physician and APRN team had significantly fewer hospitalizations.

14 Results The physician and APRN team had substantially more patients completing treatment. The average number of physician appointments in the control groups was nearly twice that of the experimental group even though the patients were evaluated on average with approximately the same number of visits.

15 Strengths and Limitations The review included a control group and an experimental group which strengthens the results. The review sample was small making it difficult to generalize findings. This was a retrospective review versus a wellcontrolled study which allows for multiple extraneous variables to influence study results.

16 Oncology Medical Home Model Centers for Medicare and Medicaid specialty model trial beginning in Payment arrangements based on six month episodes triggered by chemotherapy initiation. Goal is to increase coordination of care and decrease costs. Center for Medicare & Medicaid Services. (2015). Oncology Care Model Frequently Asked Questions. Retrieved from: ttp://innovation.cms.gov/files/x/ocmfaqs.pdf+ Kline, R.M., Bazell, C., Smith, E., Schumacher, H., Rajkumar, R., & Conway, P.H. (2015). Centers for Medicare and Medicaid Services: Using an episode-based payment model to improve oncology care. Journal of Oncology Practice, 11(2),

17 Practice and Process Changes Chemotherapy class: Added to treatment regimens and considered a requirement. Triage nurses and Call Us First campaign. Triage Advanced Practitioner. Survivorship visits added to treatment regimens. Standardized survivorship care plans built into the EMR.

18 Survivorship Care Plans 120% 100% 80% 60% SCP 40% 20% 0% 2016 Jan Feb Mar Apr May Jun

19 Survivorship Visits Visits Jan Feb Mar Apr May Jun Jul

20 Survivorship Clinic Advanced practitioner led clinic Transition care after completion of survivorship visit Allows physician to focus on treatment patients Frees physician to see more new patients Coordinate with surgeons to avoid duplicate visits

21 Conclusion As treatment innovations continue to improve cancer survival, models for providing comprehensive survivorship care will become increasingly important. Through this journey we have improved organizational outcomes using a team model of care with improvements in lower costs, better resource utilization, increased workflow efficiency, and improved patient satisfaction.

22 Winning!

23 References American Cancer Society. (2014). Cancer treatment and survivorship: Facts & figures Atlanta, GA. American Cancer Society. (2016). Cancer Facts & Figures Atlanta, GA: American Cancer Society. American Society of Clinical Oncology. (2014). The State of Cancer Care in America, 2014: A Report by the American Society of Clinical Oncology. Journal of Oncology Practice. doi: /jop Balogh, E. P., Ganz, P. A., Murphy, S. B., Nass, S. J., Ferrell, B. R., & Stovall, E. (2011). Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop. Oncologist, 16(12), doi: Bauer, J. C. (2010). Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness. Journal of the American Academy of Nurse Practitioners, 22(4), doi: /j x

24 References Brennan, M. E., Gormally, J. F., Butow, P., Boyle, F. M., & Spillane, A. J. (2014). Survivorship care plans in cancer: a systematic review of care plan outcomes. British Journal of Cancer, 111(10), doi: Campbell, M. K., Tessaro, I., Gellin, M., Valle, C. G., Golden, S., Kaye, L.,... Miller, K. (2011). Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network. Journal of Cancer Survivorship, 5(3), doi: Downs-Holmes, C., Dracon, A., Svarovsky, T., & Sustin, M. (2014). Development of a Survivorship Program. Clinical Journal of Oncology Nursing, 18(0), doi: /14.CJON.S Flannery, M., Phillips, S. M., & Lyons, C. A. (2009). Examining telephone calls in ambulatory oncology. Journal of oncology practice/american Society of Clinical Oncology, 5(2), doi: /jop Gilbert, S. M., Dunn, R. L., Wittmann, D., Montgomery, J. S., Hollingsworth, J. M., Miller, D. C.,... Montie, J. E. (2015). Quality of life and satisfaction among prostate cancer patients followed in a dedicated survivorship clinic. Cancer, 121(9), doi:

25 References Grant, M., De Rossi, S., & Sussman, J. (2015). Supporting Models to Transition Breast Cancer Survivors to Primary Care: Formative Evaluation of a Cancer Care Ontario Initiative. Journal of Oncology Practice, 11(3), e doi: /JOP Halpern, M. T., Viswanathan, M., Evans, T. S., Birken, S. A., Basch, E., & Mayer, D. K. (2014). Models of Cancer Survivorship Care: Overview and Summary of Current Evidence. Journal of Oncology Practice. doi: /jop Hewitt, M., Greenfield, S., & Stovell, E. (2005). From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press. MacDonald, G. (2014). Framework for Program Evaluation in Public Health: A Checklist of Steps and Standards. Mason, H., DeRubeis, M. B., Foster, J. C., Taylor, J. M., & Worden, F. P. (2013). Outcomes evaluation of a weekly nurse practitioner-managed symptom management clinic for patients with head and neck cancer treated with chemoradiotherapy. Oncology Nursing Forum, 40(6), doi:

26 References McCollum, K. H., Wood, F. G., & Auriemma, K. (2014). Evaluation of a breast and colon cancer survivorship program. Clinical Journal of Oncology Nursing, 18(2), doi: Miller, K., Merry, B., & Miller, J. (2008). Seasons of survivorship revisited. Cancer J, 14(6), doi: /PPO.0b013e31818edf60 Miller, R. (2008). Implementing a survivorship care plan for patients with breast cancer. Clinical Journal of Oncology Nursing, 12(3), doi: Mullan, F. (1985). Seasons of survival: Reflections of a physician with cancer. The New England Journal of Medicne, 313(4), Naumann, F., Munro, A., Martin, E., Magrani, P., Buchan, J., Smith, C.,... Philpott, M. (2012). An individual-based versus group-based exercise and counselling intervention for improving quality of life in breast cancer survivors. A feasibility and efficacy study. Psycho-Oncology, 21(10), doi:

27 References Parry, C., Kent, E. E., Forsythe, L. P., Alfano, C. M., & Rowland, J. H. (2013). Can't see the forest for the care plan: A call to revisit the context of care planning. Journal of Clinical Oncology, 31(21), doi: /JCO Stricker, C. T., & O'Brien, M. (2014). Implementing the Commission on Cancer Standards for Survivorship Care Plans. Clinical Journal of Oncology Nursing, 18, doi: /14.CJON.S Taylor, C. (2013). Reach for recovery: evaluating a pilot study of a colorectal cancer survivorship programme. European Journal of Oncology Nursing, 17(2), doi: