Tag Archives: 2017 ACCC Innovator Awards

Taking Lung Cancer Screening on the Road

Carolinas HealthCare System, Levine Cancer Institute will be honored with a 2017 Innovator Award at the ACCC 34th National Oncology Conference in Nashville, in October, for their development of the first mobile CT unit for lung cancer screening in the U.S., bringing state-of-the-art technology to rural communities. 

By Mellisa Wheeler, BSW, MHA, and Derek Raghavan, MD, PhD

As the oncology community is well aware, despite improvements to the early diagnosis, systemic immunotherapies, and gene-directed treatments of lung cancer, mortality rates remain high for this disease. A number of factors underlie this high death rate: the nature and natural history of the disease itself, poor access to care among continuing and recent smokers, lack of health education, fiscal and cultural issues, social stigma, and geographical isolation, among others. When patients present with Stage 1 (localized) lung cancer, surgical cure is possible in more than 50% of cases; when patients present with metastatic disease, for practical purposes, cure is highly unlikely.

Given that geographical isolation and barriers to care access are such important determinants of outcome, the Levine Cancer Institute sought to develop a program that would help to identify and eliminate barriers in high-risk and underserved communities.

Supported by a grant from the Bristol-Myers Squibb Foundation and in collaboration with Samsung and Frazerbilt, Levine Cancer Institute has developed the first mobile CT lung cancer screening unit in the United States.

Our mobile screening vehicle consists of a conventional low-dose Samsung CT unit mounted onto a robust, well-sprung truck body, with a built-in clinical space.  Initial testing has demonstrated the fidelity of the unit, as well as the lack of impact of on- and off-road transportation on the functionality and image quality of the scanner.

We have also created a mechanism for electronic image transfer for reporting at a central location by the staff of partner radiology groups like Charlotte Radiology, Stanly Imaging, and Shelby Radiological Associates. Watch our video and learn more.

The entire program, one of several lung cancer projects of different types supported by the Bristol-Myers Squibb Foundation, is directed toward underserved and under-privileged populations. Our program includes several social components, including outreach and education on lung cancer screening for local physicians, nurse navigation and education, patient outreach with smoking cessation programs, and meticulous follow-up to avoid the loss of patients with identified lesions. Carolinas HealthCare System, the largest safety-net health organization in the Carolinas, has committed to providing optimal care to any patients shown to have lesions requiring further investigation, irrespective of their ability to pay; this care includes follow-up and repeat scanning; biopsy; and surgical, radiation, or systemic treatment.

We have already identified cases of early stage disease that have been directed towards definitive and hopefully curative treatment. In addition to the potential to improve patient outcomes, surgical treatment of early stage lung cancer is far less costly to the community than palliating the disease via systemic therapy. Through our program, we anticipate much improved outcomes for lung cancer treatment at a substantially reduced cost in the community.


Mellisa Wheeler, BSW, MHA, is Disparities & Outreach Manager, Levine Cancer Institute, and Derek Raghavan, MD, PhD, FACP, FRACP, is President, Levine Cancer Institute, Carolinas HealthCare System.

Hear details on the Levine Cancer Institute lung screening program and see their mobile CT unit at the ACCC 34th National Oncology Conference in Nashville, Oct. 18-20. Browse the full agenda.

 

Chemotherapy Drug-Specific Education: Putting Information at the Patient’s Fingertips

As we continue to better understand the many diseases encompassed under the name, “cancer,” we are also seeing an increase in the number and complexity of anti-cancer treatments. These exciting advances are taking place while cancer programs are striving to empower patients with education about their diagnosis and treatment journey and continually improve the patient experience of care. In this guest blog post, Dr. James Weese, vice president, Aurora Cancer Care, describes his program’s 2017 ACCC Innovator Award winning approach.

By James Weese, MD, FACS

The Challenge
Oncologists, nurses, and other cancer care staff across the country work tirelessly to find the best way to deliver a patient’s treatment plan, including the type of chemotherapy treatment recommended and side effects patients may experience. In the aftermath of hearing the words, “You have cancer,” the life-changing ripple effects of that diagnosis can make it challenging for patients and their families to absorb all the details and fully understanding the treatment plan that’s ahead.

At Aurora Cancer Care, we wondered how we could provide better information in a consistent manner to patients across our large geographical area. Information that could be delivered in the office and reviewed in the comfort of the patient’s home. We offer cancer care in 19 communities from the Wisconsin-Illinois border all the way up to Marinette, Wisconsin, and diagnose nearly 8,000 new cases each year.

That’s a lot of people who need to hear consistent messages and in a way that’s convenient for them.

Our team at Aurora Cancer Care set out to address this challenge while creating a more meaningful experience for patients and their families. Under the leadership of Kerry Twite, MSN, RN, a certified oncology clinical nurse specialist with Aurora Cancer Care, a series of more than 125 educational videos were developed to provide a more personalized experience to patients. Four key principles guided the development of the video series:

  1. All patients need basic information about chemotherapy prior to treatment.
  2. Most drugs today are given in combination with other drugs.
  3. Patients want to share educational information with family and friends who may not be able to attend each appointment.
  4. Patient education from nursing teams can vary depending on multiple factors, including available time, location, and number of other potential interruptions during the session.

The Video Solution
With these tenets in mind, our team developed more than 125 chemotherapy educational videos featuring Aurora Cancer Care physicians, nurses, and other staff. Each education video a patient receives includes three videos:

  • First, a chemotherapy video explains basic principles of chemotherapy, including how it is administered (oral or intravenous), the different types of drugs, and potential side effects and complications.
  • Then, a video provides specific information about each drug the patient will receive.
  • Finally, a “Cancer SOS” video, details for patients how to manage their care at home and when to call their physician or go to the emergency room.

All the educational videos are housed on a password-protected website. When patients receive their treatment plan, they are emailed a link and password to the specific drug treatment that they will be receiving. Patients can then watch the video before their next appointment in the comfort of their home, and they can also share the video with family and friends who may have questions. Patients can then come to their next appointment with specific follow-up questions. Patients and families can access and watch each video as many times as they wish.

Learn more on our education program in this video.

Results
Patients have shared with our nursing team how helpful they’ve found these videos in preparing themselves (and their families) for the road ahead. More engaged patients mean higher patient satisfaction scores, and we’ve certainly seen that too, though it’s very early in the roll-out of the video series to see a major shift.

Our video series has also allowed nursing staff to focus on other educational tasks during the patient’s appointment while still ensuring consistent educational information for patients is provided throughout the treatment process.

At Aurora Cancer Care, our focus rests solely on the delivering the best care possible to patients throughout our region and helping them fight and overcome the disease. We are honored to be named the recipient of a 2017 ACCC Innovator Award for our patient educational video series, and hope it might inspire other cancer centers to explore similar educational tools for patients.

Learn more about how we developed our video series during our presentation at the ACCC 34th National Oncology Conference, Oct. 18-20, in Nashville, TN.


James Weese, MD, FACS, is vice president, Aurora Cancer Care, Milwaukee, Wisc.

Meet all of the ACCC 2017 Innovator’s at the ACCC 34th National Oncology Conference in Nashville. Browse the full agenda. Early bird registration rates run through Monday, August 21.

Navigation Caseload Quandary?

Learn about 2017 ACCC Innovator Award winner USA Mitchell Cancer Institute’s homegrown Oncology Navigation Acuity Tool.

By Rev. Diane Baldwin, RN, OCN, CBCN, and Meredith Jones, MS, BSN, RN

FinalSealUnfortunately, nurse navigation services are typically non-revenue generating, necessitating a cost/benefit evaluation of these services for many programs. To justify nurse navigation in this new era of value-based care, we must define appropriate caseload volumes through risk stratification, and determine how best to allocate nurse navigation time and resources among those caseloads.

How Best to Measure & Define Acuity?
Acuity tools have been used in healthcare for decades and have proven successful as a means of determining staffing needs, improving patient care, and controlling costs.  Most acuity tools score patients on a scale of specific attributes. For nurse navigation programs, an acuity tool can be used to determine caseloads and aid in more efficient nurse navigator caseload management.

At USA Mitchell Cancer Institute, our nurse navigators, known as Clinical Care Coordinators, maintain a caseload of approximately 175 patients. However, as we identified more patients needing navigation services, we recognized the need for an acuity tool specifically for caseload management.

As we researched acuity tools, we found limited options related to oncology nurse navigation. Each of the tools we identified was specific to a facility, and was either used to determine overall staffing or focused specifically on the amount of time spent with patients.  We believed that a more generalized tool, including more patient factors, was needed to accurately determine patient acuity. Therefore, the USA Mitchell Cancer Institute began developing an Oncology Navigation Acuity Tool, universally designed to benefit our practice, while also allowing for use and adaptation by other cancer programs.

More Than Just a Number
USA Mitchell Cancer Institute’s goal was to develop a tool that measures a patient’s acuity through a holistic lens. As cancer care providers know, each patient’s navigation needs depend on a variety of factors. Our Oncology Navigation Acuity Tool considers 11 factors that we identified as directly correlating with patient resource utilization and, therefore, acuity level.  Each factor is reviewed individually to determine the acuity score, placing less emphasis on cancer type and stage, and more emphasis on overall patient context. For example, two patients with the same type and stage of cancer, receiving the same treatment, may present with different comorbidities and levels of family support, resulting in two very different acuity scores.

An inherit weakness in most acuity tools is that the “score” assigned to the patient determines overall acuity. However, we know that our patients are more than just a number.  Standardized tools often fail to identify important elements needed to address individual patient needs. Therefore, our Oncology Navigation Acuity Tool includes a 12th factor in determining a patient’s acuity: The clinical assessment of the nurse navigator.  This factor is essential to assessing the “whole patient” and our aim of providing holistic care.  Our nurse navigators use the 11 factors of Oncology Navigation Acuity Tool as a guide to assess the acuity of the patient and combine this with their overall clinical assessment, for a final acuity score.  Ultimately, our nurse navigators, may elect to change the acuity level based on their assessment of the individual patient.

Putting the Tool to Work
The Oncology Navigation Acuity Tool allows us to easily assess the needs of each navigated patient prior to caseload allocation and to quickly determine the level of navigation the patient will need. The tool has also guided managerial decisions to adjust caseloads based on acuity rather than patient count alone.  Further, we’ve utilized this tool for both quality and process improvement to study the varied needs of patients among the acuity levels, and to determine the effect of accurately navigated patients on system utilization and cost.

In our presentation at the ACCC 34th National Oncology Conference, October 18-20, in Nashville, TN, we’ll share more on how using this low-cost, simple to implement tool has resulted not only in a cost-effective, efficient means of refining navigation utilization, but also in the delivery of more personalized, comprehensive, improved quality of care for our navigated patients.

We look forward to seeing you in Nashville!


Rev. Diane Baldwin, RN, OCN, CBCN, is Manager, Quality Assurance, and Meredith Jones, MS, BSN, RN, is Director, Quality Management, at the USA Mitchell Cancer Institute.