apersu webinar series
TRANSCRIPT
8/11/20
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APERSU Webinar Series
https://apersu.ca/webinars/
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The Use of Routinely Collected PROMs Data in CancerControl Alberta
A Fireside Chat with CancerControl Alberta
July 30, 2020
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Introductions
Linda Watson, RN PhDScientific Director, Applied Research and Patient ExperienceCancer Research and Analytics, CancerControl Alberta, AHS
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Acknowledgements• Funding from:
Provincial PRO Team members:– Louise Smith, PRO Business Analyst– Lindsi Chmielewki, PRO Change Management Consultant– April Hildebrant, PRO Change Management Consultant– Éclair Photitai, PRO Consultant– Andrea DeIure, PRO Consultant– Siwei Qi, PRO Research Associate
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How did this all get started?
1 in 2 Albertans will develop Cancer in their lifetime
In 201920,473 Albertans heard the words “you have cancer” for the first time
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Measurement of Patient Experience
Nationally Validated Ambulatory Oncology Patient Satisfaction Survey every 2 years since 2004
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PROMs:Creating
More Person Centred
Care Experiences
Adapted from NHS, 2014
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Responding to PROMs in clinical practice
Adapted from NHS, 2014
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How were PROMs implemented and where are we now?
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Talking About what Matters To You: Putting Patients First (PPF)
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Integration into Standard Workflow:
PATIENT TAKES COMPLETED PPF
FORM INTO CLINIC
PATIENT COMPLETES PPF FORM IN
WAITING ROOM
RECEPTIONIST GIVES PATIENT PPF AT
CHECK IN
• All Clinical Receptionists aware of purpose of PPF and how to explain the importance of completion to patients at check in
• Review of PPF and how to use it to provide tailored care is integrated into nursing orientation
• Used as a communication tool with patients and other clinicians about symptoms, concerns and clinical next steps
• Integrated into Clinical Documentation Standards and templates• CCA standard operating procedure created and organizationally endorsed
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PPF process implemented at all Ambulatory Cancer
Services in Alberta
• Large Tertiary Cancer Centres
• Calgary• Edmonton
• Regional Cancer Centres• Grand Prairie• Red Deer• Lethbridge• Medicine Hat
• community infusion clinics distributed across rural communities
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How are we using the data
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CLINIC LIST REPORT
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SYMPTOM TRACKING REPORT
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SYMPTOM CLUSTER REPORT(S)
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Data Warehouse
Before Clinic
In Clinic
After Clinic
57% 18% 14%
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An individualized score assigned to each unique encounter where the patient has completed a Putting Patient First (PPF)
It weighs the severity of the symptom scores as well as the number of problems the patient is encountering and provides an overall summary score for that encounter
Defining Symptom Complexity Score
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Intention: To Identify Patients with Complex Symptom Burden
Purpose to flag those who are experiencing multiple high symptoms at the same time
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A patient with mild symptom complexity
60%
40%
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A patient with moderate symptom
complexity
60%
40%
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A patient with high symptom complexity
60%
40%
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How are we using aggregate PRO data
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Frequency of Visits and PPFs at one CCA site over the four COVID months (one week comparisons)
815 792
1150
1350
383
544
883969
579
1266
923
743
1591 119 94
0
200
400
600
800
1000
1200
1400
1600
April 13-17 May 11-15 June 15-19 July 13-17
Visits in personPPF in personVisits VirtualPPFs virtual
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Breakdown of types of referrals pre-COVID and during the pandemic at one CCA site
0
5
10
15
20
25
30
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Home Care Nutrition OT/PT/SLP Other Pain Clinic PalliativeCare
Pharmacy Psychology Social Work
Feb 24-27 (Base) April 27-30
Decrease
25%
Decrease
25%
Decrease
56%
Decrease
68%
Increase
150%
Decrease
33%Increase
18%Decrease
13%Decrease
27%
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PATIENT DIRECTENTRY OF PROS AT HOME
CLINIC PREPARATIONPROS ARE REVIEWEDBY RN/ONCOLOGIST ALONG SIDE OTHER CLINICAL DATA (BLD WK, TX CYCLE, CT SCANS)
AT HOME PRE-CLINICLOW SYMPTOM BURDEN GOOD BLOOD
WORK NO SCANS TO REVIEW
MODERATE SYMPTOM BURDEN
SEE IN CLINIC
HIGH SYMPTOM BURDEN
DISCUSS SYMTPOM MANAGEMENT PLAN AND SEE IN CLINIC
VIRTUALCLINICAPPOINTMENT
CLINIC OPTIMIZATION23
What Value Add has PROMs had to CCA
1. MICRO
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Symptom Distribution in Clinical Environments (MO Tx)
Based on 560 TX clinic chart audits
~ 90 per population 60%
40%
% %GI 19% 11%Breast 18% 12%Heme 16% 15%GU 16% 18%lung 20% 19%Gyne 18% 22%H&N 19% 30%
2. MESO
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LOW SYMPTOM BURDEN MODERATE SYMPTOM BURDEN
HIGH SYMPTOM BURDEN
Test if PROs can help identify the dose, intensity and route of health care required?
3. MACRO
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What can be done to enhance the value we get out of PROMs?
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Thank You
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https://apersu.ca/wp-content/uploads/2020/01/APERSU-PROMs-White-Paper.pdf
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Previous Webinars: https://apersu.ca/webinars/• Collecting, analyzing and interpreting EQ-5D Data• The use of EQ-5D in Program Evaluation • The use of EQ-5D in Economic Evaluations• The use of EQ-5D in Clinical Practice• Comparing PROMs/EQ-5D data with population norms • The use of PROMs/EQ-5D in economic analysis • Disease-specific PROMs: when and how to use them • Minimally important difference of PROMs: What is it, and when and how to use it? • How can we use routinely collected PROMs data to support decision-making within the healthcare system?• The Use of Routinely Collected PROMs Data in Community Rehabilitation in Alberta
Contact: [email protected]
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