Leveraging the electronic health record (EHR) to support survivorship care planning for bone marrow transplant (BMT) survivors.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 57-57
Author(s):  
Mandy Swiecichowski ◽  
Amye Tevaarwerk ◽  
Mark Juckett ◽  
James Edward Haine ◽  
Kirsten Norslien ◽  
...  
Keyword(s):  
Primary Care ◽  
Systems Engineering ◽  
Information Needs ◽  
Patient Data ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Roles And Responsibilities ◽  
Survivorship Care Planning

57 Background: BMT survivors are underrepresented in survivorship research, yet are at high risk for complications. Practice guidelines are vague, non-BMT clinicians are inadequately informed, and communication between BMT and non-BMT clinicians is inconsistent. Our objective is to develop EHR-integrated survivorship care planning that is user-centered, supports non-BMT clinician and survivor needs, but does not adversely impact clinical workflow. Methods: A multidisciplinary team of clinicians (primary care, oncology, BMT), engineers, and EHR analysts used a systems engineering approach to identify barriers and facilitators to BMT survivorship care planning. The team identified patient data categories to include in BMT survivorship care plan (SCP) templates, as well as examined tasks, technology, workflows and individual roles and responsibilities necessary to support care planning. Results: Facilitators include: potential for EHR to discretely capture individual diagnosis and treatment data to create accurate SCPs addressing survivor and primary care information needs. Barriers are: lack of EHR inter-operability which prevents sharing of patient data outside the BMT center’s EHR system, reliance on manual entry of critical data elements into the SCP (i.e. majority of the 88 patient data categories, identified by the team, are non-discrete in the EHR), inefficient or absent survivorship workflows, lack of resources (including time, dedicated clinical staff, space, SCP content), poorly defined roles and responsibilities for survivorship care provision, and lack of evidence-based BMT survivorship guidelines. Conclusions: Work system barriers impede use of the EHR to support survivorship care planning. Steps to overcome barriers: design discrete fields in the EHR to support patient-level data capture, re-engineer existing workflows to support survivorship care planning, obtain BMT program consensus on SCP content, and evaluate user-centeredness of SCPs. This research has the potential to improve feasibility and sustainability of survivorship care planning activities, resulting in improved communication and care coordination for BMT survivors.

Perspectives Among Primary Care Providers and Hematologist/Oncologists in the Coordination of Care for Patients with Hematologic Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3156-3156
Author(s):  
Haleh Kadkhoda ◽  
Clare Karten ◽  
Kevin C. Oeffinger ◽  
Kanti R. Rai ◽  
S. Frieda Pearce ◽  
...  
Keyword(s):  
Primary Care ◽  
Hematologic Malignancies ◽  
Primary Care Providers ◽  
Shared Care ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Roles And Responsibilities

Abstract Abstract 3156 Introduction Clinicians have different expectations and perceptions regarding the role of primary care providers (PCPs) and hematologist/ oncologists (Hem/Oncs) in the provision of follow-up and survivorship care for patients with hematologic malignancies, and for the cancer survivor in general [Cheung JCO 2009]. The continuing decline in the number of specialists will require PCP involvement in the care of the patients with hematologic malignancies in particular, as well as cancer survivors in general. An outcomes study investigated barriers to shared care/ co-management of patients with hematologic malignancies and current practices of PCPs and Hem/Oncs regarding communication, provider roles and responsibilities and resources needed to implement effective cancer survivorship care plans. Methods: Internet polling surveys within an educational activity developed by the Leukemia & Lymphoma Society (LLS) and Medscape LLC with outcomes assessment by CE Outcomes, LLC. The activity learning objectives centered on roles and communication touch points for PCPs and Hem/Oncs, strategies and tools for optimal patient care, and recommendations for care of survivors with hematologic malignancies. Case-based education was delivered by an expert panel of hematologist/oncologist and primary-care physicians to illustrate critical communication points between Hem/Onc and PCP. The activity addressed regional variations in care, fragmentation of care, and helped define healthcare provider roles in the shared–care model. Electronic health records (EHR) and a treatment summary form were discussed as methods for effectively communicating a survivorship care plan among healthcare providers. More than 4, 000 physicians participated in the activity; 170 specialists and 587 PCPs were respondents to the survey. Polling questions and outcomes survey addressed barriers and current practices in shared care of patients with hematologic malignancies. Responses of PCPs and Hem/Oncs were aggregated and compared to identify gaps in continuity of care between specialties. Results: A summary of interactivity responses of PCPs (N=587) and Hem/Oncs (N=170) shows the most significant barrier to co-management of patients with hematologic malignancies was “lack of defined roles and responsibilities for PCPs vs specialists” (51.5% Hem/Onc vs 53.2% PCP). Confusion over roles is evident as 55.6% of Hem/Onc respondents expect the oncology specialist to follow the patient during the “watch and wait' period, while 45.8% of PCPs expect the PCP to follow the patient, and 35.4% expect the PCP and specialist to follow the patient together. More than half of PCPs and specialists report that they should co-manage follow up for cancer recurrence. The majority of PCPs and specialists report that standardized communication tools are from “very to extremely important” yet only approximately one third of PCPs and specialists are currently using EHR resources, with a third in the process of implementing EHR in their practices. Conclusions: Barriers to the provision of shared care and co-management of the cancer survivor can be addressed by more clearly defining individual clinician roles and responsibilities. Bridging gaps in the survivorship care plan requires improved communication between Hem/Oncs and PCPs to coordinate “watch and wait” care and follow-up screening, and effective methods to transfer patient records and history including Treatment Summary Forms and EHR. Disclosures: No relevant conflicts of interest to declare.

Implementing survivorship care planning in a large integrated cancer program.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 69-69
Author(s):  
Jamie Cairo ◽  
Carol Huibregtse ◽  
Adam Ferry ◽  
James L. Weese
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Care ◽  
Breast Cancer Survivors ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Care Plans ◽  
Survivorship Care Planning

69 Background: Aurora Health Care is comprised of 15 hospitals and 22 oncology clinics. Aurora Cancer Care (ACC), a Commission on Cancer (CoC) accredited program, diagnoses and treats 7,000 adult cancer patients annually, more than any other healthcare system in Wisconsin. The CoC’s Survivorship Standard 3.3 requires accredited cancer programs to provide cancer patients with survivorship counseling and a written care plan. ACC was challenged to develop a consistent model of survivorship care that can work at multiple sites across the system. Methods: Workflow planning and education began at all oncology clinics in fourth quarter of 2014. Thirteen disease specific survivorship care plan templates were built into the EMR with some-auto population functionality. A system wide delivery plan was launched in first quarter of 2015 with the goal of targeting 10% of eligible patients. Initial focus was on breast cancer patients with some sites also including other cancers. The model of survivorship care is an “embedded consultation” in medical or surgical oncology with an advanced practice provider (APP) completing the care plan and meeting with the patient at the end of first line treatment. Results: Initial required volumes were estimated based on 2013 registry data with a goal of completing approximately 700 care plans in 2015 to meet the 10% CoC standard. During Q1 & Q2 of 2015, 444 care plans were generated and given to patients, mostly for breast cancer survivors. The most significant barrier surrounded retrieving data from the EMR. Conclusions: Data from the first half of 2015 demonstrates success with the approach. Aurora Cancer Care will exceed the benchmark of 700 care plans. There has been a high level of engagement with the APPs who have taken ownership of survivorship care planning, contributing to the success of the program thus far. Because of difficulty retrieving data from the EMR, manual tracking was still required. Future modifications will address this and other barriers.

scholarly journals Survivorship care planning in neuro-oncology

2018 ◽  
Vol 5 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Heather E Leeper ◽  
Alvina A Acquaye ◽  
Susan Bell ◽  
Jennifer L Clarke ◽  
Deborah Forst ◽  
...  
Keyword(s):  
Critical Time ◽  
The United States ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care Plans ◽  
Care Planning ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Care Plans ◽  
Survivorship Care Planning

Abstract Cancer patient survivorship has become a significant topic within oncology care for both adult and pediatric patients. Starting in 2005, the Institute of Medicine recommended the use of survivorship care plans to assist patients transitioning from active treatment to the posttreatment phase of their cancer care, a critical time for many patients. Since 2014 there has been a mandate within the United States for adult cancer patients treated with curative intent to receive survivorship care plans comprised of a treatment summary and a follow-up plan to facilitate a better understanding among patients of what to expect after treatment. In addition to a general oncology survivorship care plan, specific care plans have been created for breast, lung, prostate, and colon cancers, as well as lymphoma. A survivorship care plan specific to adult neuro-oncology has been developed by a multidisciplinary and interprofessional committee, with approval from the Society for Neuro-Oncology Guidelines Committee. It has been published in compendium with this review of survivorship care planning and available as a fillable PDF on the Society of Neuro-Oncology Guidelines Endorsement web page (https://www.soc-neuro-onc.org/SNO/Resources/Survivorship_Care_Plan.aspx). Implementation of this survivorship care plan provides a unique opportunity to begin addressing the range of survivorship issues our neuro-oncology patients navigate from diagnosis to end of life.

A model for delivering survivorship care: Integrating the oncology and the primary care setting: Follow-up of the first cohort of patients.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 40-40
Author(s):  
Elena Lorenzi ◽  
Lucia Morello ◽  
Rita Mazza ◽  
Isabella Maria Giovanna Garassino ◽  
Raffaele Cavina ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Stage ◽  
Cumulative Risk ◽  
Latency Period ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Median Latency ◽  
Early Stage Disease

40 Background: In our Institution, we started a survivorship care program that integrates survivors’ health care provided by the oncologist and the primary care physician (PCP).We present the follow-up analysis of the first cohort of patients (pts) enrolled from April to July 2015. Methods: We included adult pts affected by hematologic or solid tumors without evidence of disease from at least 5 years (yrs). They are referred to the PCP with a survivorship care plan. An online platform for cancer survivors (CS) and their PCPs will be available. Progression free survival (PFS), overall survival (OS) and treatment related clinical events were calculated after 17 months from the start of the project. Results: We analyzed data from 269 CS. The median age was 67 yrs, they were mainly females (77%). The most frequent histological types were breast (157), colorectal (37), and hematologic (30) tumors. 189 pts had an early stage disease. 161 pts received chemotherapy with 95 pts receiving anthracycline-based-chemotherapy (ABC), 86% at a cumulative dose > 240 mg/mq. 154 pts underwent radiation therapy (RT), 94% at a dose > 30 Gy. 58 pts received both ABC and RT. The 10-yr cumulative risk of secondary cancer (SC) was 4% with a median latency period from the first cancer diagnosis of 11.3 yrs. 15-yr OS was 98% (one patient died of myocardial infarction), and 15-yr PFS was 96%. The 10-yr cumulative risk of late cardiologic toxicity (LCT) was 11% and 37 pts developed cardiologic complications with a median latency period from treatment of 10.5 yrs. The adhesion to the survivorship care plan was 84%. 13% of pts returned to our Center. The main non-clinical reason for returning was the lack of confidence in PCP. No association was observed between ABC and/or RT exposure and LCT or SC development. Conclusions: In this cohort of patients a high risk of LCT was observed. The risk and latency of SC was similar to the ones reported in literature. The number of cardiac events and SC is too low to give solid conclusions about the association with therapeutic exposure. So far, the compliance of patients and PCPs with the program was high. More data and longer follow-up period are necessary to confirm the accuracy of this model of care.

Survivorship care plan (SCP) program development within a large hospital network.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 42-42
Author(s):  
Natalie Garces ◽  
Tara Eaton ◽  
Beth York ◽  
Chasse Margot Bailey-Dorton ◽  
Wendy G. Brick
Keyword(s):  
Program Development ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Implementation Barriers ◽  
Large Hospital ◽  
Cancer Program ◽  
Hospital Networks ◽  
Survivorship Care Planning

42 Background: Barriers to SCP delivery are pervasive, with limited data available on strategies to address implementation barriers. Despite the variety of models for SCP-based survivorship care planning, there is a dearth of studies on SCP program development for larger hospital networks. Large networked hospital systems, including the Levine Cancer Institute (LCI), have unique challenges for implementing a SCP program. Methods: Beginning in 2014, LCI implemented a process for delivery of SCPs across its network of 8 Commission on Cancer accredited hospitals. Obstacles to implementation were evaluated and methods of establishing procedures for insuring SCP delivery were reviewed. Improvement in SCP delivery was measured over 3 years. SCP program development involved leveraging technology, developing processes for identifying eligible survivors, and engaging providers and practice managers in this key organizational initiative. Results: In 2014, the SCP program consisted of 3 advanced care providers (ACPs) in 3 LCI medical oncology clinics, delivering SCPs to 67 (2%) of the eligible 3,336 survivors. In the second year of implementation, 14 ACPs and 4 MDs delivered 348 (11%) SCPs to eligible survivors in 14 LCI clinics. By the end of the 2016 calendar year, it is estimated that > 1,029 SCPs ( > 25%) of eligible survivors will receive a SCP throughout the LCI hospital network. Conclusions: While challenging to deliver, SCPs are important both for cancer program accreditation and for communication between patients and physicians. At its large, multi-center cancer program, LCI has implemented a number of methods and protocols to insure that eligible patients receive informative and timely SCPs. LCI’s processes have resulted in an improvement in the number of SCPs delivered and have also served to eliminate obstacles to increasing the number of SCPs that will be delivered in the future. It is recommended that oncology practices consider the methods and interventions that LCI found helpful to improve SCP delivery in large hospital networks. It is also encouraged that oncology practices to continue to share their methods with other centers to promote eventual SCP delivery to eligible survivors.

Navigating the Transition From Cancer Care to Primary Care: Assistance of a Survivorship Care Plan

2016 ◽  
Vol 43 (6) ◽  
pp. 710-719 ◽  
Author(s):  
Jeannine Brant ◽  
Karyl Blaseg ◽  
Kathy Aders ◽  
Dona Oliver ◽  
Evan Gray ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Care ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Assistance

Perspectives on Post-Treatment Cancer Care: Qualitative Research With Survivors, Nurses, and Physicians

2007 ◽  
Vol 25 (16) ◽  
pp. 2270-2273 ◽  
Author(s):  
Maria E. Hewitt ◽  
Annette Bamundo ◽  
Rebecca Day ◽  
Catherine Harvey
Keyword(s):  
Cancer Survivors ◽  
Primary Care Physicians ◽  
Post Treatment ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Psychosocial Needs ◽  
Nurses And Physicians

Purpose Cancer survivors have many medical and psychosocial needs that are unaddressed in the post-treatment period. Qualitative research was carried out to assess how a survivorship care plan created by oncologists could improve the quality of survivorship care. Participants and Methods Focus groups and interviews conducted with cancer survivors, nurses, primary care physicians, and oncologists provide insights into post-treatment follow-up practices and the acceptability and feasibility of providing survivors and referring physicians with a cancer survivorship care plan. Results Cancer survivors reported satisfaction with post-treatment medical care, but felt that their psychosocial needs were not met. Survivors expressed enthusiastic support for receipt of a follow-up care plan. Primary care physicians viewed themselves as playing an important role during the post-treatment period and indicated that a written care plan for follow-up would help them improve their survivorship practices. Nurses recognized the need to improve the care of cancer survivors and suggested that they could play an active role in creating and implementing cancer survivorship plans. Physicians providing oncology care acknowledged the value of survivorship care plans, but were not inclined to complete them because such plans would not reduce other reporting and communication requirements and would be burdensome to complete given their busy schedules. Conclusion Survivorship care planning is viewed favorably by consumers, nurses, and physicians, however there are several barriers to its adoption. Barriers may be overcome with: electronic medical records, changes in reporting requirements of insurers, advocacy on the part of patients, and incorporation of care planning in education and training programs.

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