Defining high-quality NSCLC care at U.S. cancer centers.

229 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on individual components of care and advocate multidisciplinary collaboration, guidance spanning the complete patient journey is lacking. We aimed to compile quality-focused recommendations for the multidisciplinary team and selected clinical criteria for ideal NSCLC care, and propose a new set of metrics encompassing the entire care continuum. These metrics would be used as a new benchmark for ideal NSCLC care via the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy to compile evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Quality recommendations were organized within key care areas of the patient journey: care coordination and patient education, diagnosis and biomarker testing, staging and treatment planning, and survivorship. Results: A total of 32 recommendations were included across the 4 key NSCLC care areas. Key quality recommendations are listed (Table). Conclusions: The full set of recommendations define ideal NSCLC care and serve as a valuable guide for multidisciplinary practice and quality improvement initiatives. [Table: see text]

Download Full-text

What constitutes high-quality NSCLC care? Overarching quality considerations for improving NSCLC care at US cancer centers.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19181 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19181-e19181

Author(s):

Mark A. Socinski ◽

Leigh Boehmer

Keyword(s):

Care Coordination ◽

Quality Care ◽

Multidisciplinary Care ◽

Steering Committee ◽

Patient Journey ◽

Cancer Centers ◽

Clinical Criteria ◽

Multidisciplinary Practice ◽

National Quality ◽

Care Guidelines

e19181 Background: While clinical guidelines for non-small cell lung cancer (NSCLC) provide recommendations on specific individual components of care and advocate multidisciplinary collaboration, guidance on multidisciplinary care spanning the complete patient journey is lacking. Quality-focused recommendations for the multidisciplinary team, along with selected clinical criteria for ideal NSCLC care, were compiled, and a new set of metrics encompassing the entire care continuum was proposed. These metrics were used to set a new benchmark for ideal NSCLC care through the Association of Community Cancer Centers’ (ACCC) national quality care initiative for patients with advanced (stage III/IV) NSCLC. Methods: The ACCC convened an expert steering committee of multidisciplinary specialists and representation from patient advocacy, who identified and compiled evidence-based recommendations via a systematic search of clinical and quality care guidelines and peer-reviewed journals. Ideal quality recommendations were organized within key care areas of the patient journey: care coordination, diagnosis, and treatment. Results: A total of 32 recommendations were included. Of these, 9 were key unpublished recommendations on NSCLC care, including diagnosis and biomarker testing, treatment planning, care coordination, and patient education (Table). Conclusions: These recommendations define the criteria for ideal NSCLC care and serve as a valuable resource to guide multidisciplinary practice and quality improvement initiatives. [Table: see text]

Download Full-text

Improving Care for Patients With Stage III or IV NSCLC: Learnings for Multidisciplinary Teams From the ACCC National Quality Survey

JCO Oncology Practice ◽

10.1200/op.20.00899 ◽

2021 ◽

pp. OP.20.00899

Author(s):

Ravi Salgia ◽

Leigh M. Boehmer ◽

Catherine Celestin ◽

Hong Yu ◽

David R. Spigel

Keyword(s):

Lung Cancer ◽

Multidisciplinary Team ◽

Advanced Nsclc ◽

Quality Care ◽

Stage Iii ◽

Tumor Board ◽

Standards Of Care ◽

Multidisciplinary Teams ◽

National Quality ◽

Biomarker Testing

PURPOSE: Insufficient characterization of the optimal multidisciplinary team and lack of understanding of barriers to quality care are unmet needs in the management of stage III or IV non–small-cell lung cancer (NSCLC). A national survey was conducted to inform the design and execution of process improvement plans and address identified barriers. METHODS: A steering committee of multidisciplinary specialists and representation from patient advocacy collaborated for a comprehensive, double-blind, web-based survey (January-April 2019) to obtain insights on care delivery for patients with advanced NSCLC in a diverse set of US community cancer programs. RESULTS: Overall, 639 responses (160 unique cancer programs across 44 US states) were included; 41% (n = 261) of respondents indicated an absence of a thoracic multidisciplinary clinic in their cancer program. Engagement in shared decision making was significantly associated with the presence of navigation and radiation oncology disciplines ( P ≤ .04); 19.2% and 33.3% of respondents belonged to cancer programs with no lung cancer screening and no protocol for biomarker testing, respectively. The frequency of tumor board meetings negatively correlated with time to complete disease staging ( P = .03); the average time to first therapeutic intervention in newly diagnosed patients was 4 weeks. The most challenging barriers to quality care included insufficient quantity of biopsy material for biomarker testing, lack of primary care provider referrals, and diagnostic costs. CONCLUSION: Improving the quality of advanced NSCLC care, including optimization of a multidisciplinary team framework, may surmount barriers to care coordination, diagnosis and staging, and treatment planning, consequently improving adherence to evolving standards of care.

Download Full-text

Improving quality of care within the NCI Community Cancer Centers Program (NCCCP) network.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.178 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 178-178

Author(s):

Kathleen M. Castro ◽

Eliot Lawrence Friedman ◽

Nadesa Mack ◽

Robert D. Siegel ◽

Jana Eisenstein ◽

...

Keyword(s):

Quality Of Care ◽

Assessment Tool ◽

Quality Care ◽

Implementation Strategies ◽

Multidisciplinary Care ◽

Program Goal ◽

Cancer Centers ◽

Quality Reporting ◽

National Quality

178 Background: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) was initiated to expand cancer research and deliver quality cancer care in communities. A program goal was support of quality care initiatives. Twenty-one community sites in 16 states participated in the network providing care to approximately 40,000 cancer patients/year. We describe strategies for implementation of a structured quality program within our network. Methods: Four components served as the foundation for quality efforts: 1) increasing multidisciplinary care (MDC) programs; 2) ASCO QOPI participation; 3) Commission on Cancer Rapid Quality Reporting System (RQRS) participation; and 4) expansion of genetic counseling/services. A Quality of Care subcommittee formed to guide quality efforts within the network. Clinicians from the network served as subcommittee leadership and each site designated a quality of care lead. The subcommittee met by teleconference monthly, developed goals, shared best practices, developed processes to accomplish goals and documented improvements in priority areas. Results: Strategies employed to improve quality included: assessment tool development, participation in national quality reporting initiatives, review and monitoring of network data, and network performance improvement projects. Conclusions: The NCCCP identified areas of needed quality improvement. In addition, the network developed implementation strategies and created benchmarks that measure program quality. Participants benefitted from the opportunity to interface with one another and set network goals, while adopting strategies to best fit their own practices and community sites. [Table: see text]

Download Full-text

Streamlining federally mandated quality metric reporting in cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.68 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 68-68

Author(s):

Lisa M. Kidin ◽

Ronald Stewart Walters ◽

Doug Browning ◽

Sarah H Taylor ◽

Victoria S. Jordan

Keyword(s):

Early Identification ◽

Quality Care ◽

Disease Process ◽

Public Reporting ◽

Quality Data ◽

Cancer Centers ◽

Quality Reporting ◽

National Quality ◽

Longitudinal Data Collection

68 Background: Public reporting has been an established process for non-PPS exempt hospitals since the inception of the Core Measures in 2001; however, Cancer Centers were not subject to public reporting and had no standardized established formal mechanism to collect, analyze and report clinical quality data until the Affordable Care Act (ACA) of 2010. The first three Clinical Process/Oncology Care Measures must be submitted through the American College of Surgeons Rapid Quality Reporting (RQRS) system. Since registries are designed to provide a retrospective snapshot of the patient population during the first four months of the disease process, the change to longitudinal data collection, while critical for intervention in time to improve concordance, is extremely difficult for cancer centers with large volumes and complex cases. Our institution created a collaborative interdisciplinary model utilizing quality management nurses to support and enhance the submission process by utilizing an early identification and intervention process. Methods: Prior to implementation, the average submission time for the initial three oncology specific metrics was eight months due to the significant effort to determine the analytic population based on our volume of patients. In addition, many patients receive treatments outside the facility with little or no documentation that often resulted in the inability to determine metric concordance. Results: The new process identified patients at two months and created a robust follow up and validation process utilizing a model to ensure evidence based care is provided across the continuum. This enabled monthly submission to RQRS at the end of three months and leveraged the system to ensure that patients had the appropriate therapy documented in the system. This process shortened the submission time to less than half and initial projections indicate increased overall compliance. Conclusions: We enhanced the process of submission for federally mandated measures to RQRS by initiating early identification and follow up. This significantly impacted our ability to accurately represent the high quality care provided at our institution and provide documented concordance with national quality measures.

Download Full-text

Sensory Loss and the Healthcare System: Outcomes and Navigation

Innovation in Aging ◽

10.1093/geroni/igaa057.2888 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 797-797

Author(s):

Nicholas Reed ◽

Charlotte Yeh

Keyword(s):

Health Care ◽

Hearing Impairment ◽

Hearing Aids ◽

Quality Care ◽

Vision Impairment ◽

Sensory Loss ◽

Sensory Impairment ◽

Age Related ◽

Increased Risk ◽

National Quality

Abstract Communication is fundamental to patient-centered care. However, sensory impairment limits communication among older adults. Specifically, hearing impairment strains communication via degraded auditory encoding while vision impairment distresses ability to read and interpret visual cues. The presence of dual sensory impairment, defined as concurrent hearing and vision impairment, may exacerbate these effects. The potential consequence s of age-related sensory loss on health care interactions and outcomes are beginning to surface in epidemiologic studies demonstrating poorer patient-provider communication, higher medical expenditures, increased risk of 30-day readmission, and longer length of stay when compared to individuals without sensory loss. Importantly, these associations may be amenable to intervention via sensory aids; however, uptake to sensory care is low. Notably, less than 20% of persons with hearing impairment have hearing aids and over 55% of Medicare Beneficiaries with reported vision problems have not had an eye examination in the prior year. Affordability and access may contribute to lack of sensory care uptake as Medicare explicitly excludes coverage of vision and hearing services. In this symposium, we will review current and new evidence for whether sensory loss affects health care outcomes, including satisfaction with care, incident delirium during hospitalization, navigation of Medicare, and present data on how persons with sensory loss are more likely to delay their care independent of cost and insurance factors suggesting fundamental changes in health care system interaction. We will place these results within the context of current national quality care and policy initiatives and review methods to address sensory loss.

Download Full-text

PATIENTS’ JOURNEY THROUGH INFLAMMATORY BOWEL DISEASE (IBD): A QUALITATIVE STUDY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.127 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S53-S54

Author(s):

Tina Aswani Omprakash ◽

Norelle Reilly ◽

Jan Bhagwakar ◽

Jeanette Carrell ◽

Kristina Woodburn ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Qualitative Study ◽

Patient Experience ◽

Bowel Disease ◽

Quality Care ◽

Diagnostic Testing ◽

Healthcare Providers ◽

Indeterminate Colitis ◽

Patient Journey ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) is a debilitating intestinal condition, manifesting as Crohn’s disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC). The patient experience is impacted by a lack of awareness from other stakeholders despite growing global disease prevalence. To gain deeper insight of the patient experience, promote quality care, and enhance quality of life, we performed a qualitative study of the patient journey starting from pre-diagnosis through treatment. Methods U.S. patients with IBD were recruited via UC/CD support groups and organizations, social media platforms, blog followers, and personal networks. Participants were screened via an emailed survey and asked to self-identify as medically diagnosed on the basis of reported diagnostic testing. Interviews were conducted by qualitative researchers by phone or web conferencing. Open-ended questions were developed to support and gather information about our learning objectives—primarily, our desire to understand the unique experiences of UC/CD patients in their journey from symptom onset through diagnosis, treatment and maintenance (e.g. “Upon diagnosis, what were your immediate thoughts about the condition?”). This qualitative data were analyzed using Human-Centered Design methodology, including patient typologies (personas), forced temporal zoom (journey maps), forced semantic zoom (stakeholder system mapping), and affinity mapping for pattern recognition of unmet needs. Results A total of 32 patients were interviewed: N=17 CD patients, N=13 UC patients and N=2 IC patients. The interviewed population reflected regional, demographic, and disease-related diversity (Table 1). Five unique, mutually exclusive journeys were identified to understand and classify patient experiences: (1) Journey of Independence, (2) Journey of Acceptance, (3) Journey of Recognition, (4) Journey of Passion and (5) Journey of Determination (Figure 1). Patients with IBD expressed a need for increased awareness, education, and training for providers to shorten the path to diagnosis. Mental health support was found to be a critical gap in care, particularly for major treatment decisions (e.g., surgery). The inclusion of emotional support into the treatment paradigm was perceived as essential to long-term wellness. Patient attitudes and self-advocacy varied on their individual journeys; understanding these journeys may accelerate time to diagnosis and treatment. Conclusion Better understanding of patient journeys can help healthcare providers improve their approach to patient care and coordination.

Download Full-text