nurse navigator - inacc.org · acc – cardio-oncology web page herrmann j, lerman a, sandhu np,...
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NurseNavigator
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OurStart� ACardiologistandanOncologist� Enlistleadershipfromcardiologyandoncology
� Committeeformedwithkeystakeholders:Cardio-oncologyboard
� Members:keyphysicians,leadership,businessdevelopmentandmarketing
� Goal:Toinvestigateopportunitiesanddetermineprogramcoursedevelopmentforidentifiedpatientpopulation.
� Approach-NurseNavigator� Criteria–cardiology/oncology
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Approach� Nursenavigatormodelwithinoncologypractice
� 10oncologistpractice–communityhospital� Identificationofpatients–toolforriskassessment� Cardiacsurveillance–monitoringprocesses� Referralprocess� CardiologyandOncologysupport
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ApproachCRS-theiden4fica4ontool
� CRS–tool(Mayoclinic) � HerrmannJ,LermanA,SandhuNP,VillarragaHR,MulvaghSL,KohliM.Evaluation
andmanagementofpatientswithheartdiseaseandcancer:cardio-oncology.MayoClinProc.2014;89(9):1287–306
� Presentationtooncologyboard� Scope:allpatientswillbescreened� Initiationoftool:admissionprocess� NewEMR� Interim:navigatorcompleteandfollowidentifiedpatientsthroughkeyprocesses
� Trackingofpatients–spreadsheetfordata
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CardiacRiskScore-CRSDrug
� 4–ex;trastuzumab–(herceptin),anthracycline-(doxorubicin)
� 2–ex:docetaxel,pertuzumab
� 1–ex:bevicitzumab–(avastin),dasatinib(Sprycel)
� 0–ex:rituxamab-rituxan
PatientRisk-1pt.each� Female� >65� HTN� DM� CHF� CAD,PVD,CVA� Radiation� PrioranthracyclinesMed+pt.risks=total
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CardiacSurveillance� Echoes
� Ordering,scheduling,timing,ownership � Quality–StrainwithDefinity� Educationandtraining� Patients–portpatients
� labs� Troponins,BNP,chemistry,CBC
� Vitalssigns� CardiacMRI,stresstest,Holters� EDandhospitaladmissions
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Deploymentofprocesses� Identificationofpatients–echo/treatmentplans� Startsmall–diseasespecificordrugspecificwithoneortwooncologists
� Troponins-timing,positiveresults� referral–algorithmwithuseofCRStool� Patientpopulation–cancerpatientswithtreatmentregimen–cycles
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Keystosuccess� Goalofoncologist:besttreatmentforpatient–getthemthroughthetreatmentbasedonNCCNguidelines
� Goalofcardiologist:assisttheoncologistwithCVmanagementsothepatientmaycontinuetherapywithminimalcardiovascularsideeffects
� Communication,promptfollowup,buildingofrelationships
� Echoprocesscompletelyreleasetonavigator� Engagementbyalloncologist� Referralprocess–gamechanger
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Learning� WAYBIGGERTHANEVERATTICIPATED–startsmall� Availabilityofcardiologist,availabilityofservices� Itsaboutthetimingofcaredeliveryfortreatmentplans–appointment/test–expectations1week
� SteeringCommitteeofworkingparticipantsforongoingevaluationandprogrambuild
� Clinicalteam–cardiologists,navigator,echotechs,schedulersetc.
� Contactedkeyprovidersinfieldtobestpracticeandfuturedevelopment
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Coding� ListasmanyICD10codespervisitthatarewarranted,allcancerdiagnoses� Billingcodesaretheonlywaytheinsurerknowsthepatientsco-morbidities� Somespecificcardiacdiagnosticcodes
Z4889:Encounterforotherspecifiedsurgicalaftercare
Z5111:Encounterforantineoplasticchemotherapy
Z5112:Encounterforantineoplasticimmunotherapy
Z5189:Encounterforotherspecifiedaftercare
Z92.3hxofradiationtherapy
Z91.89Atriskforcardiomyopathy
Z92.21hxofantineoplasticchemotherapy
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Oncologistperspec4veaboutcardio-oncology
� “Theproactiveapproachhelpstoprovidebetterandmoreappropriatetreatmentplansforourpatients.”
� “Thecollaborativeclinicmakescareforourpatientsapriority”
� “Theyhavehelpedtomodifytreatmentplanswithcardiovasculardiseasesothatthepatienthasbettertoleranceandtreatmentprogression”
� “AssistwithvolumecondensingwhichhasmadehugedifferencewithourCHFpatientsmanagement”
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Oncologist’scomments� “Withtheincreasedattentiontoourpatient’scardiacstatuswecanmovethroughourpatient’streatmentplanswithmoreeaseandconfidence.”
� “Thefollowupisamazingandourpatient’ssatisfactionwiththemiswonderful;theykeepeveryoneconnected.”
� “Theinitiationoftheprogramwasadesirableneedforourpatientsbuttheimpactandramificationithashadforourpatientsisdefinitelyobviousfrommyownobservationperspective.Iamsurestatisticaldatawouldalsosupportthis.”
� “Idon’tknowhowwediditwithoutyou.”
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Data
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NextSteps� Firmupfoundationprocesses� Clinic� Education
� Cardio-oncologyCaseconference–quarterly� DevelopmentofIndianapolisCardio-oncologySociety� Dialoguewithothercardio-oncologistsinsurroundingstatestostartpatientdatabase
� Research-Datacollection–whatisittellingus
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Resources� ACC–Cardio-oncologywebpage� HerrmannJ,LermanA,SandhuNP,VillarragaHR,MulvaghSL,KohliM.
Evaluationandmanagementofpatientswithheartdiseaseandcancer:cardio-oncology.MayoClinProc.2014;89(9):1287–306.
� AlbertoDolci,MD,1RobertoDominici,MD,1DanielaCardinale,MD,2MariaT.Sandri,MD,3andMauroPanteghini,MD1,4.BiochemicalMarkersforPredictionofChemotherapy-InducedCardiotoxicitySystematicReviewoftheLiteratureandRecommendationsforUse.ClinicalChemistry–biomarkersofcardio-oncologytoxcity.AmJClinPathol2008;130:688-695
� CardinaleD,SandriMT,ColomboA,ColomboN,BoeriM,LamantiaG,etal.PrognosticvalueoftroponinIincardiacriskstratificationofcancerpatientsundergoinghigh-dosechemotherapy.Circulation.2004;109(22):2749–54.
� CardinaleD,SandriMT,MartinoniA,TriccaLabTechA,CivelliM,LamantiaG,etal.LeftventriculardysfunctionpredictedbyearlytroponinIreleaseafterhigh-dosechemotherapy.JAmCollCardiol.2000;36(2):517–22.58.CardinaleD,SandriMT,MartinoniA,BorghiniE,CivelliM,LamantiaG,etal.