the everett clinic @ providence regional cancer ... · high value cancer care marilyn birchman, rn,...
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The Everett Clinic @ Providence Regional Cancer Partnership
High Value Cancer Care
Marilyn Birchman, RN, MSN, AOCNSRegional Director, PRCP
Kelly Mardesich, RN, BSN, MHA (c)Clinical Practice Manager, TEC
Renee Curtis, PharmD, BCOPManager, Clinical Pharmacy, TEC
May 3, 2018Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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Goal of Cancer Care
• Value= Quality /Total Cost.
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PRCP: FOCUS on QUALITY
• American College of Surgeons Commission on Cancer—Outstanding Achievement Award – 2 consecutive awards - uniqueachievement
• National Accreditation Program for Breast Centers (NAPBC)
• Quality Oncology Practice Initiative (QOPI) participant since 2006and QOPI Certified since 2014
• Hutchinson Institute for Cancer Outcomes Research (HICOR)
• Stanford Study participant
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Critical Lessons From High-Value Oncology Practices
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HICOR/Stanford Study- PRCP/high value practice
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• Unique Attributes of High-Value Practices– Treatment Planning: A Conservative Approach to Diagnostic Testing:
– Treatment Planning: Setting Goals After Explicit Discussion on the Benefits,Limits, and Consequences:
– Support for the Patient Journey:
– Care Team Functions at the Highest Level of Competence and License:
– External Context: Close affiliation with a large and generally hospital-basedhealth system.
Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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How did we do it?
• Very little data
• Follow Core Values
• Focus on Quality
• Teamwork
• Results will follow
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Hospitalization during chemotherapy Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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Hospitalization During Chemotherapy
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Hospitalization during chemotherapy Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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Low rates for ED & inpatient admits
Physician buy-in is critical
Support of department leadership decisions
Must be trust in nursing staff to make independenttriaging decisions
Trust and respect for clinical decision-making ofadvanced practitioners, including clinical pharmacy
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Building a culture within nursing
TEC #1 Core Value – do what is right for the patient
RN works at top of license –Stanford study“maximal use of registered nurses for
interventions”
Keep patient out of the ED, whenever possible Patients added on to provider schedule without
permission Advanced practitioner appointment built into
schedule for daily add-on’s
Direct admission processMeeting on a regular basis w/inpatient leaders
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Recommended Treatment for Breast, Colorectal and Lung Cancers
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Making your EMR work for your practice
Focus is on proactively preventing side effects and toxicities
Labs & toxicity checks built into care plans
Antiemetics built into all regimens per NCCN guidelines
Growth factors built into appropriate care plans
Outpatient neutropenic protocol built by clinical pharmacistto avoid admissions for neutropenia
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Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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Regimen build
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End of Life Care
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Palliative & end of life care
• QOPI End of life module• Palliative care team – collaboration between in and
outpatient• Continual education and discussions with providers• Nursing allowed to refer without initial discussion with
MD• Initiation of weekly palliative care conference
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Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content
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Questions?
Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content