How to Improve Compliance with Survivorship Care Plan in Cancer Centers? - Quality and Systems, 2021

Quality and Systems, 2021 Case

The Commission on Cancer (COC) is a quality certification program through the American College of Surgeons. Your hospital has been COC certified for a number of years and you are responsible for maintenance of this certification. If the certification lapses, the Cancer Center Director, Department of Surgery Chief, and the Chief Medical Officer will be concerned.

 

There is a new certification that requires that >75% of patients treated with curative intent receive a Survivorship  Care Plan within 1 year from diagnosis. The target is not 100% since not all patients are appropriate to receive such documents and there is opportunity for physician discretion. You are supposed to reach this threshold before the next site visit in 12 months.

 

Through a data analysis from the Tumor Registry, you learn that your institution is below that and is at less than 50%. It is your sense that there is variability in which disease groups currently complete these, and how efficiently and effectively they are completed.

You review this new standard with the different cancer disease programs at your academic institution and with various stakeholders including nursing leadership, information technology and the tumor registry leadership. The tumor registry is a department of chart reviewers that abstract and document all new cancer diagnoses and treatments at your hospital and reports this information to the government.

 

Disease programs include breast, rectal, other gastrointestinal, head and neck, genitourinary, gynecologic, cutaneous, immunotherapy, hematologic malignancy, and thoracic oncology. You also review this new standard with a community oncology center that is under your certification. There is also an active patient advisory council. 

 

The stakeholders have different perspectives on this issue:

 

• Nurse coordinators and nurse practitioners: This is an important initiative for patients and the right thing to do. Nurses want to be providing education but are stretched thin.
• Information technology: Electronic fixes are feasible if they are submitted, reviewed and prioritized. Any priority of the hospital leadership, like this one, is given highest priority.
• Tumor registry department: This is a standard we have to meet. We have some capacity to change our workflow but major investments in time will have to come with additional resources.
• Disease program physicians: This is yet another thing we have to remember to do. If the content is developed for us and accurate, it could be useful for patients.
• Patient advisory council: This is the right thing to do for patients. Presenting the information in person is better than mailed or over the phone.
• Community oncology center leadership: We need to maintain the quality certification so as to distinguish ourselves from competitors. We will get this done at all costs. 

Stakeholders' perspectives on the issue

 

You bring together the following team:

• Nurse coordinator from the clinic
• Nurse Director of the clinic
• Tumor Registry Director 
• Physician- breast cancer program
• Nurse Practitioner- hematologic malignancy program
• Physician- Medical Director of the clinic
• Patient advocate
• Community oncology center Administrative Director
• Programmer- Information Technology 

After clarifying the problem and assessing current state, you brainstorm different intervention options with your team. The intervention options include:

 

1. Nurse coordinators in each disease group will draft a survivorship care plan for each patient based off of the information on that patient in the medical record. The physician will then cosign the document after adding necessary follow-up guidance. The administrative coordinator will mail the document to patients and the nurse will have a phone conversation to discuss it.

 

2. Physician disease program leaders develop standardized content on how to monitor patients for cancer recurrence and long term side effects of specific cancers and treatments. This content will be uploaded into the electronic health record as a macro. With standardized content, physicians will be able to create the survivorship care plans themselves.

3. The tumor registrar will draft the survivorship care plan for each patient based off of the information on that patient in the medical record when asked to do so by a physician. The physician will then cosign the document after adding necessary follow-up guidance.

4. A Survivorship Advanced Practice Provider clinic with nurse practitioners will be opened for two sessions a week. As part of their job descriptions, nurse practitioners will create and discuss survivorship care plans with each individual patient referred to them by physicians. 

Part ( A )Questions: 600 words

 

1. In 1-2 paragraphs, describe how you would guide your team in prioritizing among interventions and selecting one. 200 words

 

2. Anticipate one pro and one con for each of the four interventions that you may expect to hear from your team. 100 words each

 (i)   Intervention 1: pro/con:
 (ii)  Intervention 2: pro/con: 
 (iii) Intervention 3: pro/con:
 (iv) Intervention 4: pro/con

For the purposes of this project, despite the pros and cons, the team decides to move forward with Intervention #2:

 

Physician disease program leaders develop standardized content on how to monitor patients for cancer recurrence and long term side effects of specific cancers and treatments. This content will be uploaded into the electronic health record as a macro. With standardized content, physicians will be able to create the survivorship care plans themselves.

 

Part ( B )Questions: 200 words

 

Create a project timeline for this project with a go-live date in the first half of 2022. You can use template project timeline, Gantt chart, or create a list with dates included below in word.

The project is launched successfully in all disease programs however the community oncology center initially experiences challenges that they are able to overcome. By June 2022, the rate of completion of Survivorship Care Plans across all disease programs and the community oncology center is 90%.

 

Part ( C )Questions: 200 words

 

In 1-2 paragraphs, how could you ensure any early successes are sustained?